LAPAROSCOPIC GASTROESOPHAGEAL ANTIREFLUX SURGERY

Recent improvement in the understanding of gastro-oesophageal antirefl ux mechanisms and the pathophysiology of the gastro-oesophageal reflux disease (GERD) has warranted the concept that antireflux surgery prov ides a valid, and sometimes superior, alternative to medical therapy i n selected patients. The main indications for surgical treatment of sy mptomatic GERD are: failure of medical therapy to heal ulcerative oeso phagitis or to prevent recurrence of stricture or other complications, and the development of aspiration pneumonia or other air-way complica tions. The Belsey and Nissen fundoplication and the Hill posterior gas tropexy are the three most widely used surgical procedures to control reflux. The success rate of these operations, performed openly, in rel ieving symptoms and healing the lesions is 80-90 %. The laparoscopic a pproach provides an interesting alternative in antireflux surgery. It affords a potential to reduce some inherent complications of conventio nal surgery, provided the operator is technically experienced and well aware of the pathophysiological principles of this disease. It is als o superbly convenient to the patient. The currently published short-te rm results of laparoscopic antireflux surgery are comparable to those of open surgery, but the technique is still young, and its final evalu ation is not possible until long-term results are available.