Fundoplication is an effective treatment for gastro-oesophageal reflux disease

Antireflux surgery is an appropriate therapeutic option in patients with persistent or recurrent symptoms and/or complications of gastro-oesophageal reflux disease. The patients who are most likely to benefit from the procedure are those in whom the cause of the increased oesophageal acid exposure is a mechanically defective lower oesophageal sphincter. At present, antireflux surgery is the only treatment that is able to modify the natural history of reflux oesophagitis. Trans-abdominal Nissen fundoplication is the current technique of choice for the treatment of gastro-oesophageal reflux disease. A consensus has emerged over the past decade on some technical modifications of the original procedure which are important to minimize its side-effects: shortening the wrap to about 2cm in length, sizing the wrap around a large indwelling bougie, and making a loose wrap. When the operation is performed with the correct indications and complying with established technical principles the success rate is very high. Nissen fundoplication can now be performed laparoscopically. Early reports indicate the safety and efficacy of this approach. The clinical and physiological outcome are similar to that of open fundoplication. The procedure is technically demanding and should only be performed by a surgeon trained in open surgery and in advanced laparoscopic techniques.