Laparoscopic fundoplication for GERD: are we there yet?

Although proton pump inhibitor treatment remains the first-line treatment for gastroesophageal reflux disease (GERD), the panorama of an indefinitely prolonged medical treatment faces patients and physicians with the need to look for an equivalent, more definitive therapy. Facing global results, after many series have demonstrated the safety of the laparoscopic antireflux surgery procedure in experienced hands, with a low incidence of intra- and postoperative morbidity and a short postoperative hospital stay (averaging 2 days), the immediate benefit as well as the long-term alleviation of symptoms (very good: 82%, good: 92%) seem to justify the place of surgical fundoplication in the therapeutic armamentarium for GERD as a valid alternative to medical treatment. Careful patient selection for surgery, a complete and thorough preoperative workup, an intervention in experienced hands, and a patient well informed about the pros and cons of both medical and surgical therapy are mandatory.