Minimally invasive surgery for gastroesophageal reflux disease.

Surgical treatment of gastroesophageal reflux disease (GERD) is indicated for patients with moderate to severe signs and symptoms or a need for increasing doses of antisecretory drugs. Long segment Barrett's metaplasia is another indication, especially in young patients. Preoperative evaluation differs somewhat depending on whether the patient's symptoms are typical or atypical of GERD. Laparoscopic fundoplication is described. Follow-up of as long as 8 years indicates that more than 90% of patients are satisfied with the results, although 14% are using antisecretory drugs regularly. Recurrent symptoms or dysphagia may indicate surgical failure, and medical therapy, esophageal dilatation, or surgery may be appropriate. Laparoscopic surgery in these patients takes longer than the original procedure but has many benefits if performed by an experienced surgeon.