For patients with objective evidence of gastroesophageal reflux disease, antireflux surgical intervention represents a structured long-term management pathway. Procedure selection depends on clinical presentation, anatomical findings, and patient preference.

This protocol addresses patients with confirmed GERD who are candidates for surgical management, including those with severe esophagitis, significant anatomical findings, or persistent troublesome symptoms, as well as those who prefer minimally invasive alternatives to conventional antireflux surgery.

Approach overview: The protocol covers antireflux surgical intervention performed by an experienced surgeon, along with alternative procedures for eligible patients who prefer to avoid conventional surgery. Patient-specific factors determine which approach applies — the complete selection criteria and decision pathway are in the full protocol.

References

DOI: 10.14309/ajg.0000000000001538

We recommend antireflux surgery performed by an experienced surgeon as an option for long-term treatment of patients with objective evidence of GERD, especially those who have severe reflux esophagitis (LA grades C or D), large hiatal hernias, and/or persistent, troublesome GERD symptoms.

We recommend consideration of magnetic sphincter augmentation (MSA) as an alternative to laparoscopic fundoplication for patients with regurgitation who fail medical management.

We suggest consideration of transoral incisionless fundoplication (TIF) for patients with troublesome regurgitation or heartburn who do not wish to undergo antireflux surgery and who do not have severe reflux esophagitis (Los Angeles grades C or D) or hiatal hernias >2 cm.

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Surgical Treatment Options for Gastroesophageal Reflux Disease

References