Laparoscopic antireflux surgery; the merits and problems.

The development of laparoscopic techniques has enhanced interest in surgical treatment of gastro-oesophageal reflux disease. The goal of laparoscopic surgery in this context is to achieve the same results as in open surgery with fewer complications, shortened hospital stay and reduced sick leave. Several surgical procedures, based on surgical rearrangement of the oesophageal gastric junction or placement of prosthesis, are available. Most of these procedures are applicable in laparoscopic surgery. Surgical treatment of gastro-oesophageal reflux is highly effective although postoperative gas bloat syndrome, dysphagia and recurrence may occur in a small number of patients. In published series short-term results of laparoscopic antireflux surgery have been excellent. The benefits of minimal invasive surgery, such as less painful postoperative course, shortened hospital stay and rapid recovery have been confirmed. Because of the enthusiasm for laparoscopic technique, surgeons not familiar with the surgical treatment of gastro-oesophageal reflux may be tempted to embark on this procedure. This type of surgery is, however, technically demanding and should be performed only by surgeons with significant experience with both laparoscopic surgery in general and open antireflux surgery. A sufficiently long learning period is mandatory if serious complications are to be avoided. Taking into account these premises, laparoscopic antireflux surgery is safe and represents a viable alternative to conventional antireflux surgery.