An Analysis of Operations for Gastroesophageal Reflux Disease

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Abstract
A BETTER understanding of the pathogenesis of gastroesophageal reflux disease (GERD) and the development of minimally invasive techniques during the past decade have not been accompanied by a consensus on what constitutes an optimal antireflux operation. Operations are still being performed and referred to just as they were described more than 30 years ago, and discussions about technique too often seem to pivot on which one is best. The problem with this thinking is that the Nissen, Toupet, Lind, Guarner, and Hill procedures1-6 sprung from the intuition of these surgeons during a time when much less was known about the pathogenesis of GERD, and the testing and follow-up to validate their efficacy was scant. It is unlikely that any of these procedures as originally described constitutes the ideal operation for GERD. Each, however, contains important technical elements that are shared to a greater or lesser extent by the entire group. The goal of this study was to identify the elements of genuine importance.