Secrets for successful laparoscopic antireflux surgery: patients with collagen diseases
Gastroesophageal reflux disease (GERD) in patients with connective tissue disorders (CTDs) is often severe, and complications such as erosive esophagitis, strictures, and Barrett’s metaplasia may worsen the patient’s clinical course. Medical treatment is effective in most cases; however, symptoms often do not improve. In addition, PPIs reduce the pH of refluxate but have almost no effect on the backflow of gastroesophageal contents into the esophagus. Hence, medical therapy should give way to surgical correction of reflux in selected cases. Even though worsening of dysphagia after a fundoplication remains a concern in these patients, as their esophageal body motility is often severely compromised, laparoscopic antireflux surgery (LARS) should be considered as an effective treatment, as outcomes have been proven good in selected patients.