Secrets for a successful laparoscopic antireflux surgery: patients with extraesophageal symptoms

The outcomes for antireflux surgery in patients with extraesophageal symptoms of gastro esophageal reflux disease (GERD) are usually worse compared with patients with esophageal symptoms. This paper focuses on how to obtain a successful laparoscopic antireflux surgery in patients with extraesophageal symptoms. A successful laparoscopic antireflux surgery in patients with extraesophageal symptoms depends on: (I) an objective diagnosis for GERD. The diagnosis of pathological distal reflux is straightforward; however, the diagnosis of proximal reflux and to the target organs may be hard to be established; (II) the attribution of the symptoms to GERD. Extraesophageal symptoms may have a different cause than GERD even in the presence of GERD. A rational and complete workup is necessary to answer this question. A single test is not able to correlate symptoms to GERD. Judicious clinical decision based on a sum of different pieces of information is needed; and (III) the correct selection of patients based on predictors for good outcomes to show those who would benefit from surgery. Adequate surgical technical principles should be followed.