Indications for surgery:
- Objective evidence of GERD plus:
- Complications of GERD not responding to medical therapy (e.g. esophagitis, stricture, recurrent aspiration or pneumonia, Barrett’s esophagus). Barrett’s esophagus is one of the most serious complications of GERD, since it may progress to cancer!
- GERD symptoms interfering with lifestyle, despite medical therapy
- Hiatal hernia with GERD
- Need for continuous drug therapy in a patient desiring discontinuation of medications (e.g. financial burden, non-compliance, lifestyle choice, young age, etc.)
- Presence of extraesophageal manifestations of GERD may indicate the need for surgery (eg, cough, wheezing, aspiration, hoarseness, sore throat, otitis media, etc.)
Contraindications
Absolute
- Inability to tolerate general anaesthesia
- High Bleeding Risk
Relative
- Previous abdominal surgery close to the hiatal region
- Severe obesity
- Esophageal shortening
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