J Korean Med Assoc.  2022 Dec;65(12):821-828. 10.5124/jkma.2022.65.12.821.

Surgical treatment for gastroesophageal reflux disease

• Kim JJ

• KMID: 2537216
• DOI: http://doi.org/10.5124/jkma.2022.65.12.821

Abstract

Background
Gastroesophageal reflux disease (GERD) is one of the most common upper gastrointestinal diseases that affects 10% to 20% of the general population worldwide.
Current Concepts
Proton pump inhibitors (PPIs), the main treatment for this disease, is used to control symptoms. In most cases, PPI is prescribed empirically, and may be ineffective in 30% to 40% of patients. Even in cases with a precise diagnosis of GERD following objective tests, PPI becomes less effective as the disease progresses over a long time period. Laparoscopic anti-reflux surgery can be a good option when PPI therapy becomes ineffective and dose increases are required. This surgery effectively abolishes all kinds of reflux by constructing a mechanical anti-reflux valve at the gastroesophageal junction. Before surgery, a precise diagnosis should be made following several objective tests, including esophagogastroduodenoscopy, pH monitoring, manometry, and esophagram. The degree of fundoplication should be tailored according to esophageal motility and disease severity.
Discussion and Conclusion
Laparoscopic anti-reflux surgery may be particularly effective for GERD patients with hiatal hernia, mechanically defective lower esophageal sphincter, or weak acidic/nonacidic reflux.

Keyword

Gastroesophageal reflux; Surgical procedures; Laparoscopy; Fundoplication; 위식도역류; 수술기법; 복강경술; 위바닥주름형성술