Surgical therapy for atypical symptoms of GERD - Patient selection and preoperative evaluation

Patients are selected for surgery for extraesophageal manifestations of gas troesophageal reflux disease (GERD) after medical therapy failure, medical noncompliance, or because of a desire to change from medical therapy. Preop erative assessment of patients with extraesophageal manifestations of GERD is tailored to the four types of symptoms: noncardiac chest pain, pulmonary , laryngeal, and oropharyngeal. Prior to surgery, all patients should under go 24-hour pH testing and manometry. Indicators of a good response to surge ry are an initial response to medication and positive 24-hour pH test resul ts.