Laparoscopic surgery for gastroesophageal reflux disease: Nissen, Toupet or anterior fundoplication

Mario Morino, Elettra Ugliono, Marco Ettore Allaix, Fabrizio Rebecchi

Abstract

Gastroesophageal reflux disease (GERD) is one of the most frequent upper gastrointestinal disorders worldwide. It is defined as a chronic condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. A review of literature has been performed to evaluate the adequate preoperative diagnostic workup, indications to anti-reflux surgery, and surgical outcomes. To establish a correct indication, objective diagnosis of GERD with endoscopy, 24-hour impedance-pH monitoring and esophageal manometry is needed. A careful preoperative selection of patients is the first critical step to reduce the risk of side effects and failure of laparoscopic anti-reflux surgery (LARS). Laparoscopic 360° fundoplication (LTF) is the gold standard surgical treatment for GERD. Relief of heartburn and regurgitation is achieved by 80–90% of patients at 10 years follow-up. Partial fundoplications (anterior and posterior) guarantee similar outcomes in terms of symptom control with a lower risk of postoperative dysphagia. However, at the long-term follow-up, partial fundoplications are associated with an increased number of recurrent reflux episodes at 24-hour pH monitoring when compared to 360° fundoplication. More studies are needed to compare the different types of fundoplication in the long-term follow-up period.