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