The 1990s brought two major changes to the long-term management of gastroesophageal reflux disease (GERD). Proton-pump inhibitors (PPIs) have greatly improved the ability of the gastroenterologist to treat GERD and its complications with medical therapy. In the same period, the introduction of the laparoscopic approach has created a revolution in the surgical management of this disease. Successful relief of symptoms can be achieved in 90% of patients with either approach when used appropriately. As new information has been integrated, the basic approach to the surgical management of GERD, including the indications, contraindications, preoperative evaluation, and even the surgical procedures themselves, has changed from the prelaparoscopic era.

Nowhere in medicine is the old phrase, “An ounce of prevention is worth a pound of cure,” more accurate than in the area of antireflux surgery. Management of postfundoplication problems begins by preventing complications from occurring.<sup>9 Ferguson M.K. Pitfalls and complications of antireflux surgery: Nissen and Collis-Nissen techniques Chest Surg Clin North Am 1997 ;  7 : 489-511

Cliquez ici pour aller à la section Références, 37 Richardson W.S., Hunter J.G., Waring J.P. Laparoscopic antireflux surgery Semin Gastrointest Dis 1997 ;  8 : 100-110

Cliquez ici pour aller à la section Références, 40 Richter J.E. Menu for successful antireflux surgery Dig Dis Sci 1996 ;  14 : 129-131  [cross-ref]

Cliquez ici pour aller à la section Références</sup> First, many surgical failures are worse after than before surgery. Postoperative problems, such as dysphagia, bloating, or other symptoms associated with vagal nerve injury, may be quite severe, perhaps disabling. Second, the success rates of repeat operations decrease to the 75% to 85% range with high morbidity and mortality, even in expert hands. Surgical failures are more likely to occur in patients with complicated GERD, gastric motility disorders, or esophageal motility disorders. Additionally, the extensive scarring from the first operation, makes the performance of repeat operations much more technically challenging. The prevention of complications after antireflux surgery can be divided into three important areas: (1) patient selection, (2) selection of the surgery, and (3) selection of the surgeon.