Surgical Treatment of Gastro-Esophageal Reflux Disease: A Review of Concepts Misguiding the Indications for Surgery

Clinical therapies and surgical interventions are the acceptable treatments for gastro-esophageal reflux disease (GERD). Referrals for surgery are yet limited, because of disadvantages associated to surgical treatment, including: (a) high rate of mortality; (b) high risk of side effects, especially dysphagia; (c) need for acid-reducing medications after surgery; (d) need for revision surgery; (e) unclear benefit of surgery on the risk of cancer; and (f) differences in the outcomes between a community setting and a tertiary care center. In contrast, surgeons report excellent outcomes after anti-reflux operation. A thorough search in literature was performed with predefined keywords to identify relevant articles published from 1975 to January 2015, in order to analyze the complications from the aspect of current surgeon’s perspective. Our review showed that: (a) the mortality rate of the surgical procedure is negligible and PPI therapy is also accompanied with mortality; (b) there is a 5% chance of severe dysphagia after anti-reflux operation; (c) postsurgical use of PPI is not an indication of surgical failure, but often represents misuse of the medication; (d) there is a 5% chance of re-operation after surgery, often because of severe dysphagia; (e) reduction in the risk of adenocarcinoma is probable but still controversial; and (f) good results can be achieved in a community setting. A significant number of patients would benefit from surgical therapy to treat their GERD symptoms, but some incorrect beliefs still misguide the indications for the surgical procedure.