Laparoscopic Nissen Fundoplication

Medical treatment with proton pump inhibitors (PPIs) heals esophagitis and suppresses heartburn in over 90% of patients. Despite the fact that effective maintenance therapies do exist, patients often require lifelong medication, and compliance with long-term maintenance therapy is sometimes difficult to achieve. Furthermore, concerns exist regarding long-term safety of PPI medication. Current evidence suggests that laparoscopic fundoplication is more effective than medical therapy for the short- and medium-term treatment of gastroesophageal reflux disease. In contrast to medical therapy that inhibits only acid reflux, antireflux surgery is designed to prevent reflux of all gastric content. This is achieved by creating a mechanical antireflux valve that increases lower esophageal sphincter pressure and markedly reduces the rate of spontaneous transient relaxations accompanied by reflux. Side effects of Nissen fundoplication such as dysphagia, increased bloating and flatulence, and inability to belch or vomit may limit the success of antireflux surgery.