Conclusion

Patients with severe GERD and an incompetent LES do not respond well to long-term medical therapy. Overall, medical therapy with omeprazole shows a failure rate of more than 50%, and there are no long-term studies concerning the side effects of PPI's, which include increase of serum gastrin levels, micro nodular argyrophil cell hyperplasia and subatrophic and atrophic gastritis. Furthermore, increased esophageal acid exposure is only one reason for developing esophagitis; additional factors include bile reflux, esophageal dysmotility and delayed gastric emptying, which are not corrected by medical therapy.
With laparoscopic fundoplication the mortality, morbidity and length of hospitalization have decreased significantly. Antireflux surgery should be offered as an option to patients with refractory GERD due to failure of LES function. After adequate evaluation of patients, this procedure promises a long-term satisfaction rate of 87 to 100%.
In conclusion, laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication are simple and helpful surgical treatments for patients suffering from refractory GERD and are the only treatments which can restore LES function and provide long-term cure in the majority of patients with minimal discomfort and an early return to normal activity. It should only be performed by well-experienced surgeons in carefully evaluated patients.