Surgical management of gastroesophageal reflux disease

Surgical treatment of gastroesophageal reflux disease (GERD) is used in selected patients who have objective evidence of GERD. Candidates for surgery include the following: 1) heartburn and regurgitation as predominant symptoms; 2) persistent symptoms despite medical therapy; 3) intolerance to proton pump inhibitors or potassium competitive acid blockers, or associated complications; 4) presence of large hiatal hernias; 5) severe erosive esophagitis that is persistent or recurrent; and 6) in the case of extraesophageal symptoms, there should also be accompanying heartburn or regurgitation, a multidisciplinary approach to identify other diagnoses, and preferably positive symptom correlation. Laparoscopic fundoplication is the standard surgical option. The LINX system, consisting of a ring of magnetic beads that reinforces the lower esophageal sphincter, represents a minimally invasive alternative. It is indicated in patients with confirmed GERD, without hiatal hernias larger than 3 cm and without severe esophageal motility disorders. Treatment selection should be individualized, considering the patient’s clinical characteristics, underlying pathophysiology, and informed preferences.