GERD is a common ailment physicians are frequently met with in their clinical practice. Here is a methodology as to how to diagnose and approach the case and appropriate use of laparoscopic surgery in GERD.

    Team@ CMHF

Diagnosis/Evaluation

1.Flexible esophagoscopy
2.Histologic confirmation and staging of Barrett’s esophagus
3.24-Hour pH–metry
4.Multichannel intraluminal esophageal impedance (insufficient evidence for a recommendation)

Treatment/Management

1.Preoperative work-up (esophagogastroduodenoscopy [EGD], esophageal manometry, barium swallow)
2.Medical versus surgical treatment
3.Surgical technique and training
4.Laparoscopic versus open treatment of GERD
5.Partial versus total fundoplication
6.Anterior or Toupet versus Nissen fundoplication
7.Anterior versus Toupet fundoplication
8.Short gastric vessel division
9.Crural closure
10.Robotic surgery
11.Antireflux surgery in the morbidly obese patient
12.Esophageal dilators
13.Outcome risk assessment
14.Revisional surgery for failed antireflux procedures
15.Outcomes assessment (including patient quality of life and satisfaction with surgery)
16.Surveillance of Barrett’s esophagus after antireflux surgery

Major Outcomes Considered

• Quality of life
• Satisfaction with surgery
• Symptomatic relief
• Postoperative complications

Ref: http://www.guideline.gov/content.aspx?id=16257&search=Stenosis