Perfect-results after laparoscopic surgery for gastroesophageal reflux - are they achievable?
In the quest for the perfect outcome following antireflux surgery, Nissen’s original fundoplication has undergone many modifications. The original procedure achieved good reflux control, but this was offset by a relatively high incidence of troublesome side effects. The modifications which have been proposed as solutions to the problem of troublesome side effects have now all been tested in randomized trials. Outcomes from these suggest that division of the short gastric vessels during Nissen fundoplication is unnecessary, and that partial fundoplications are associated with less side effects. However, there is a trade-off between the risk of side-effects vs. the risk of recurrent reflux across the spectrum of antireflux procedures ranging from Nissen fundoplication at one end to lesser degrees of partial fundoplication at the other. Whilst a perfect outcome is almost certainly not achievable following antireflux surgery, the trade-off between the risk of reflux vs. the risk side effects needs to be considered during work-up, and the fundoplication can be tailored to the preoperative esophageal motility and individual patient preferences to achieve better outcomes.