Laparoscopic fundoplication for gastroesophageal reflux disease

Table 1 Indications for laparoscopic fundoplication

AGA	Patients with esophagitis who are intolerant of PPI therapy
	Patients with symptoms of the esophageal GERD syndrome poorly controlled by PPI therapy, especially in the setting of persistent troublesome regurgitation
	Carefully selected patients with extraesophageal GERD syndromes in whom a reflux causality has been established to the greatest degree possible
SAGES	Patients who have failed medical management (inadequate symptom control, severe regurgitation not controlled with acid suppression, or medication side-effects)
	Patients who opt for surgery despite successful medical management
	Patients who have complications of GERD (e.g., Barrett’s esophagus, peptic stricture)
	Patients who have extra-esophageal manifestations (asthma, hoarseness, cough, chest pain, aspiration)
ACG	Surgical therapy is a treatment option for long-term therapy in GERD patients
	Surgical therapy is generally not recommended in patients who do not respond to PPI therapy
	Refractory patients with objective evidence of ongoing reflux as the cause of symptoms should be considered for additional antireflux therapies, which may include surgery
	Surgery should generally not be performed to treat extraesophageal symptoms of GERD in patients who do not respond to acid suppression with a PPI

PPI: Proton pump inhibitor; GERD: Gastroesophageal reflux disease; AGA: American Gastroenterological Association; SAGES: Society of Gastrointestinal and Endoscopic Surgeons; ACG: American College of Gastroenterology.