title: Laparoscopic fundoplication for gastroesophageal reflux disease.
abstract: Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of gastric contents into the esophagus leads to troublesome symptoms and/or complications. Heartburn is the cardinal symptom, often associated with regurgitation. In patients with endoscopy-negative heartburn refractory to proton pump inhibitor (PPI) therapy and when the diagnosis of GERD is in question, direct reflux testing by impedance-pH monitoring is warranted. Laparoscopic fundoplication is the standard surgical treatment for GERD. It is highly effective in curing GERD with a 80% success rate at 20-year follow-up. The Nissen fundoplication, consisting of a total (360°) wrap, is the most commonly performed antireflux operation. To reduce postoperative dysphagia and gas bloating, partial fundoplications are also used, including the posterior (Toupet) fundoplication, and the anterior (Dor) fundoplication. Currently, there is consensus to advise laparoscopic fundoplication in PPI-responsive GERD only for those patients who develop untoward side-effects or complications from PPI therapy. PPI resistance is the real challenge in GERD. There is consensus that carefully selected GERD patients refractory to PPI therapy are eligible for laparoscopic fundoplication, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained. For this purpose, impedance-pH monitoring is regarded as the diagnostic gold standard.
authors.affiliation: Marzio Frazzoni, Leonardo Frazzoni, Digestive Pathophysiology Unit, Baggiovara Hospital, 41100 Modena, Italy.
authors.forename: Marzio
authors.initials: M
authors.lastname: Frazzoni
authors.affiliation: Marzio Frazzoni, Leonardo Frazzoni, Digestive Pathophysiology Unit, Baggiovara Hospital, 41100 Modena, Italy.
authors.forename: Micaela
authors.initials: M
authors.lastname: Piccoli
authors.affiliation: Marzio Frazzoni, Leonardo Frazzoni, Digestive Pathophysiology Unit, Baggiovara Hospital, 41100 Modena, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Conigliaro
authors.affiliation: Marzio Frazzoni, Leonardo Frazzoni, Digestive Pathophysiology Unit, Baggiovara Hospital, 41100 Modena, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Frazzoni
authors.affiliation: Marzio Frazzoni, Leonardo Frazzoni, Digestive Pathophysiology Unit, Baggiovara Hospital, 41100 Modena, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Melotti
mesh_terms: D004351:Drug Resistance; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D018579:Patient Selection; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors
keywords: Gastroesophageal reflux disease; Impedance-pH monitoring; Laparoscopic fundoplication; Proton pump inhibitors; Refractory gastroesophageal reflux disease