Surgical considerations for antireflux therapy.

Surgery has a major role to play in the treatment of reflux disease. Several factors should be considered prior to utilising the surgical approach. Severity of the reflux disease and response to conservative treatment are generally acceptable criteria for deciding whether a patient should undergo a surgical procedure. Once the decision is made to utilise a surgical approach, a specialised centre with an abundance of experienced, skilled surgeons and a specialised diagnostic laboratory should be selected. It is the responsibility of the referring physician and surgeon to diagnose accurately the presence of reflux disease. Endoscopy, pH-metry, and manometry are useful in precisely diagnosing the presence of reflux disease. Fundoplication is the favoured surgical procedure. The most common complications associated with this procedure are gas bloat and hypercontinence, which are acceptable tradeoffs for reflux disease. The patient must be educated about the surgical procedure and its consequences prior to the operation and informed of the alternatives. Accurate diagnosis, coupled with selection of an experienced surgeon and patient education can have a dramatic impact on reflux disease in the individual patient.