title: Laparoscopic Antireflux Surgery: Importance of Patient's Selection and Preoperative Workup.
abstract: BACKGROUND
  Laparoscopic antireflux surgery (LARS) is an excellent option for patients with symptoms refractory to medical treatment, for patients who have complications secondary to the use of proton pump inhibitors, and for those who do not want to take medications for a long period of time.
  
  
  OBJECTIVE
  We hypothesized that (1) LARS has excellent outcomes if a complete preoperative workup and proper patient selection are performed and (2) recurrent symptoms often are not due to failure of the fundoplication to control the pathologic reflux.
  
  
  METHODS
  Every patient referred for antireflux surgery underwent a detailed symptomatic evaluation, barium swallow, esophagogastroduodenoscopy (EGD), high-resolution manometry (HRM), and pH monitoring. A fundoplication was performed in all of them. Data were analyzed to determine outcomes across 8 years.
  
  
  RESULTS
  From 2008 to 2016, 176 patients with gastroesophageal reflux disease (GERD) underwent LARS. One hundred and thirty-four patients (76.1%) had a total fundoplication, 31 (17.6%) had an anterior partial fundoplication, and 11 (6.3%) had a posterior partial fundoplication. Thirty-nine patients (22.2%) referred persistent or recurrent symptoms after the procedure and underwent EGD, HRM, and pH monitoring. Abnormal reflux was documented in 5 patients (2.8%). Among these failures, 3 patients had a body mass index (BMI) ≥30 and 2 had ≥35.
  
  
  CONCLUSIONS
  The results of this study showed that (1) laparoscopic fundoplication is an effective procedure for GERD; (2) patient's BMI can affect the outcome of a fundoplication; and (3) pH monitoring is important to establish if recurrent symptoms are secondary to failure of the operation.
authors.affiliation: 1 Department of Surgery, University of Chicago Pritzker School of Medicine , Chicago, Illinois.
authors.forename: Ciro
authors.initials: C
authors.lastname: Andolfi
authors.affiliation: 1 Department of Surgery, University of Chicago Pritzker School of Medicine , Chicago, Illinois.
authors.forename: Yalini
authors.initials: Y
authors.lastname: Vigneswaran
authors.affiliation: 2 Department of Gastroenterology, University of Chicago Pritzker School of Medicine , Chicago, Illinois.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Kavitt
authors.affiliation: 3 Department of Surgery, Escola Paulista de Medicina, Federla University of Sao Paulo , Sao Paulo, Brazil .
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Herbella
authors.affiliation: 4 Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
authors.forename: Marco G
authors.initials: MG
authors.lastname: Patti
mesh_terms: D015992:Body Mass Index; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D016896:Treatment Outcome
keywords: achalasia; ambulatory pH monitoring; esophageal manometry; esophagitis; gastroesophageal reflux disease; heartburn