Surgical Treatment of Gastro-Esophageal Reflux Disease: A Review of Concepts Misguiding the Indications for Surgery

Abstract

Context: Clinical therapies and surgical interventions are the acceptable treatments for gastro-esophageal reflux disease (GERD). Referrals for surgery are yet limited, because of disadvantages associated to surgical treatment, including: (a) high rate of mortality; (b) high risk of side eects, especially dysphagia; (c) need for acid-reducing medications after surgery; (d) need for revision surgery; (e) unclear benefit of surgery on the risk of cancer; and (f) dierences in the outcomes between a community setting and a tertiary care center. In contrast, surgeons report excellent outcomes after anti-reflux operation. Evidence Acquisition: A thorough search in literature was performed with predefined keywords to identify relevant articles pub- lished from 1975 to January 2015, in order to analyze the complications from the aspect of current surgeon's perspective. Results: Our review showed that: (a) the mortality rate of the surgical procedure is negligible and PPI therapy is also accompanied with mortality; (b) there is a 5% chance of severe dysphagia after anti-reflux operation; (c) postsurgical use of PPI is not an indication of surgical failure, but often represents misuse of the medication; (d) there is a 5% chance of re-operation after surgery, often because of severe dysphagia; (e) reduction in the risk of adenocarcinoma is probable but still controversial; and (f) good results can be achieved in a community setting. Conclusions: A significant number of patients would benefit from surgical therapy to treat their GERD symptoms, but some incor- rect beliefs still misguide the indications for the surgical procedure.