Laparoscopic treatment of gastro-oesophageal reflux disease.

Laparoscopic antireflux surgery is now well established as a treatment of moderate to severe gastro-oesophageal reflux disease. It is indicated for patients with reflux symptoms who have not responded fully to medical therapy or who do not wish to continue medication for the rest of their lives. The evidence base for the determination of appropriate practice has expanded considerably in recent years with the publication of several important randomized trials. These trials have confirmed the superiority of fundoplication compared to medical therapy for the treatment of these patients. They have also demonstrated that the laparoscopic approach achieves an improved short-term outcome compared to the equivalent open approach. Additional trials suggest that the routine application of partial fundoplication procedures achieves equivalent reflux control and fewer side-effects than total fundoplication. Longer-term outcome studies have also been reported recently, with success rates of approximately 90% claimed at 5-8 years. Hence, laparoscopic fundoplication is now the 'gold standard' for the management of patients with more severe gastro-oesophageal reflux disease. New endoscopic treatments for reflux will need to achieve similar outcomes before they can replace the laparoscopic approach.