Laparoscopic fundoplication is the treatment of choice for gastro-oesophageal reflux disease

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Abstract
Comparison is limited by lack of randomised trials between laparoscopic surgery and modern drug therapy (that is, proton pump inhibitors (PPIs)). Although Spechler1 first reported that open ARS was significantly better than medical therapy after two or three years of follow up, the comparison involved drugs which are no longer considered as optimal therapy for GORD. Interestingly, the same author recently reassessed the long term outcome of these cohorts of medically and surgically treated patients after a median follow up of approximately 10 years.2 Oesophagitis grade, quality of life scores, satisfaction with antireflux therapy, and frequency of GORD related complications did not differ significantly between the two groups. Recently, Lundell et al compared the results of open ARS and omeprazole after three3 and five years4 of follow up in a large multicentre prospective randomised study. Results were similar when patients in the omeprazole group were allowed to adjust for the PPI dose according to individual needs. There was no evidence of any general superiority of open ARS over long term drug treatment and there was no reason to suspect that the laparoscopic approach may be more effective than the open one. Indeed, even after successful laparoscopic ARS, quality of life does not return to normal.5 Finally, oesophageal dysmotility, if initially present, is not corrected by ARS but may eventually complicate it.6