Laparoscopic Antireflux Surgery In Complicated Gastroesophageal Reflux Disease

The application of laparoscopic surgical techniques to antireflux surgery has been very beneficial to patients with uncomplicated gastroesophageal reflux disease (GERD) because it minimizes discomfort and risk. As knowledge of the pathophysiology of GERD has expanded and more complete preoperative evaluation of reflux patients has become possible, the role of laparoscopic antireflux surgery has become more clearly defined in patients with severe complicated reflux disease. Complications of GERD, including ulceration, stricture, Barrett's esophagus, foreshortened esophagus, and esophageal dysmotility are discussed in this article in relation to their preoperative diagnosis and laparoscopic surgical management With careful preoperative evaluation consisting of endoscopy, 24-hour pH analysis, barium swallow, and stationary manometry, almost all patients can be successfully managed by the laparoscopic route. One exception is esophageal shortening, which should be approached surgically through the chest.