Secrets for successful laparoscopic antireflux surgery: preoperative workup
Gastroesophageal reflux disease (GERD) is a highly-prevalent multifactorial disease, with primary symptoms including heartburn and regurgitation. Despite the widespread pharmacologic treatment of GERD, antireflux surgery is cur-rently the most effective and definitive treatment for the disease. An accurate indication for surgery and the appropriate preoperative workup are the best predictors of surgical success in those patients. Several factors affect the decision of performing anti-reflux surgery, including the patient’s response to anti-acid medication and therapy duration, presence of side-effects, and progression of disease. Other diagnoses, such as esophageal cancer, must also be ruled out. A proper preoperative workup includes esophageal symptom evaluation and esophageal testing. Ambulatory pH testing is the gold standard for GERD diagnosis, and it is crucial for the assessment of the relationship between symptom presen-tation and reflux episodes. High-resolution manometry evaluates esophageal body motility and lower esophageal sphincter function, playing an important role in the definition of the surgical technique to be adopted. Upper GI endoscopy is the exam of choice for the diagnosis of disease progression and presence of other complications. Esophagram provides a detailed anatomy of the esophagus and stomach. In summary, a meticulous preoperative workup done by experts is crucial for improving patient outcomes.