Fundoplication for GERD: Laparoscopic Approach

Abstract

Laparoscopic antireflux surgery (LARS) has assumed a major role in the treatment of gastroesophageal reflux disease (GERD). The advancement in laparoscopic techniques and instrumentation over the past two decades has led to an increase in the number of antireflux operations. Although the operation is fundamentally similar to open antireflux procedures, clear benefits to the laparoscopic approach have been described.

In 1955, Rudolf Nissen reported the efficacy of a 360° gastric wrap through an upper abdominal incision to control reflux symptoms. It was not until 1991 that the first laparoscopic Nissen fundoplication was reported. From that point, acceptance on the part of patients and physicians to proceed with surgical treatment began to grow. Although the minimally invasive approach follows the same surgical principles as the open operation, LARS reduces postoperative pain, shortens the hospital stay and recovery period, and achieves a functional outcome that is similar to, or better than, that of the open operation.