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Surgery should be considered in patients with well-documented reflux disease who cannot tolerate medications or continue to have regurgitation as a primary symptom. If symptoms persist despite medical treatment, a comprehensive evaluation should be completed prior to considering surgery. The surgery for treating reflux disease is known as fundoplication. In this procedure, a hiatal hernia, if present, is eliminated and part of the stomach is wrapped around the lower end of the esophagus to strengthen the barrier between the esophagus and the stomach. The operation is typically done via a laparoscope, an instrument that avoids a full incision of the stomach. Due to the complexity of this surgery, it is important to seek a skilled surgeon who has experience in performing this procedure and can discuss the risks and benefits of the procedure.
Surgery is a well-established treatment for gastroesophageal reflux disease (GERD) that has been shown in research trials to be as good as twice-daily medical therapy, if not better for long-term GERD management. Surgery may be the best option for those who don't want to take medications for the rest of their lives, as well as for those who have lifestyle restrictions such as limitation on diet or activity. Surgery is also likely the best option for those with more advanced GERD and who have hiatal hernia or Barrett's esophagus. Successful surgery does offer an advantage over using medications only. Additionally, the overall success rate of antireflux surgery is very high when done in a competent antireflux center. Approximately 80 percent of patients report good to excellent results after five years, and 90 percent report improved results. Ten percent will develop recurrent symptoms of reflux, and approximately five percent will need to undergo another operation.