Gastroesophageal reflux disease (GERD) is one of the most common chronic problems, and most patients face a life long regimen of medication to treat it.

For patients who don't respond well to medication or have persistent esophagitis, MIP for reflux surgery, known as laparoscopic fundoplication (LF), is now a preferred method of treatment. It is also the treatment method of choice for children and infants with reflux problems. And for patients with both asthma-like symptoms and GERD, this surgical treatment can significantly improve respiratory symptoms.

Clinically, LF is similar to an open procedure. It essentially involves strengthening the sphincter valve between the esophagus and stomach, which stops acid from backing up into the esophagus as easily.

Both MIP and open surgeries result in good clinical outcomes, but LF offers several advantages to patients over the more invasive open technique, including:

• Quicker recovery (with the ability to resume normal activities within one week instead of one month)
• Less pain and scarring
• Lower risk of complications

The basic goals of fundoplication are the same with either a laparoscopic or an open approach. Essentially, the upper curve of the stomach (fundus) is mobilized and then wrapped around the lowest part of the esophagus, creating a new sphincter valve. As opposed to an open procedure, which involves an incision of seven to nine inches in the abdomen or thoracic area, LF incorporates a few half-inch incisions. These accommodate the laparoscopic camera and the instruments used to perform the surgery.

The type of wrap is determined by the patient's reflux severity and any complications:

• Nissen fundoplication: the fundus is wrapped completely around the esophagus.

(Flash animation: MIP Nissen fundoplication versus an open procedure)

• Toupet fundoplication: a partial wrap is performed, and then the fundus is sutured into place. This wrap is intended to support the sphincter muscle so that it will not open prematurely. As a result, less gastric acid refluxes into the esophagus.

Hiatal hernia, which can cause GERD, can also be repaired during the LF procedure.

As with all operative procedures, be sure to discuss surgical risks with your patients.