What are surgical tx of GERD?

1. Indications (Evidence of severe esophageal injury (ulcer, strictures, Barrett’s..), Incomplete resolution while on medical treatment, Relapse while on medical treatment, Long duration of symptoms, Younger patients with persistent symptoms) 2. Antireflux operations: designed to mechanically restore the barrier to reflux and involve wrapping the lower esophagus with gastric fundus and restoring the distal esophagus to its original intra-abdominal position with the GEJ below the diaphragm. The following are most common. a. Nissen undoplication (360-degree wrap of the gastric fundus around the distal esophagus): usually performed laparoscopically with favorable results b. Belsey Mark IV operation (270-degree wrap): performed through a left thoracotomy c. Hill posterior gastropexy (includes a posterior 180-degree fundoplication, which is then anchored to the arcuate ligament of the diaphragm): emphasizes restoration of the LES to the intra-abdominal position