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World J Gastroenterol. Oct 21, 2014; 20(39): 14272-14279
Published online Oct 21, 2014. doi: 10.3748/wjg.v20.i39.14272
Laparoscopic fundoplication for gastroesophageal reflux disease
Marzio Frazzoni, Micaela Piccoli, Rita Conigliaro, Leonardo Frazzoni, Gianluigi Melotti
Marzio Frazzoni, Leonardo Frazzoni, Digestive Pathophysiology Unit, Baggiovara Hospital, 41100 Modena, Italy
Micaela Piccoli, Gianluigi Melotti, Department of General Surgery, Baggiovara Hospital, 41100 Modena, Italy
Rita Conigliaro, Digestive Endoscopy Unit, Baggiovara Hospital, 41100 Modena, Italy
Author contributions: Frazzoni M contributed to the concept and design of the review, analysis and interpretation of data, drafting of the manuscript; Piccoli M, Conigliaro R, Frazzoni L, Melotti G contributed to the concept of the review, analysis and interpretation of data, critical revision of the manuscript.
Correspondence to: Marzio Frazzoni, MD, Digestive Pathophysiology Unit, Baggiovara Hospital, Viale Giardini 1355, 41100 Modena, Italy. marziofrazzoni@gmail.com
Telephone: +39-59-3961201 Fax: +39-59-3961201
Received: November 26, 2013
Revised: January 30, 2014
Accepted: May 12, 2014
Published online: October 21, 2014
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.

Keywords: Gastroesophageal reflux disease, Refractory gastroesophageal reflux disease, Laparoscopic fundoplication, Impedance-pH monitoring, Proton pump inhibitors

Core tip: The present review focuses on the definition and diagnosis of gastroesophageal reflux disease (GERD), the techniques and results of laparoscopic fundoplication, and the currently accepted indications for antireflux surgery. Proton pump inhibitor-refractory GERD is thoroughly considered, with a special regard to impedance-pH monitoring criteria useful for diagnosing this condition which currently represents the main indication for laparoscopic fundoplication.