Surgical therapy for GERD: selection of procedures, short- and long-term results.

Surgical options for the supraesophageal complications of gastroesophageal reflux disease (GERD) should be considered in all patients. Although the majority can be managed successfully with medical therapy, patients with severe complications, refractory disease, or with a severely incompetent lower esophageal sphincter should be referred for surgical evaluation. The laparoscopic Nissen fundoplication achieves the same short-term outcome as the open procedure but has associated significantly less morbidity, shorter hospital stay, and more rapid return to normal function. Patients who respond to medical therapy of supraesophageal GERD complications have a predictably better response than nonresponders to antireflux surgery.