Gastroesophageal Reflux Disease

Author: Robert B. Yates, MD; Edward Verrier, MD
Institution: University of  Washington
Date Reviewed: October 2014
Learning Domain: General Thoracic
Learning Objective: Benign Esophageal Disease
PowerPoint File: Gastroesophageal Reflux Disease

Discussion Points

Surgical Management of GERD

• Diagnostic testing
  • Imaging / Endoscopy / pH monitoring
  • Manometry
• Operative approaches
  • Open vs. Lapraroscopic
  • Thoracoscopy vs. Laparoscopy
• Postoperative complications
• Nissen fundoplication
• Laparoscopic / Abdominal approach
   

Major Principles of Antireflux Surgery

• Document the diagnosis of GERD
• Evaluate the LES and esophageal body
• Identify the surgical patient
• Select the proper surgical procedure
• Understand technical nuances of the operation
  • Fundoplication for a permanently destroyed  lower esophageal  sphincter
  • Sphincter augmentation to prevent transient failure of a normal or near normal LE sphincter

Learning Points

• Gastroesphageal Reflux Disease is common
• All diagnostic tests are contributory and should be done routinely
  • Imaging
  • Endoscopy
  • 24 hour pH Monitoring
  • Manometry
• Laparoscopic antireflux surgery is associated with low perioperative morbidity and mortality