SURGICAL MANAGEMENT OF GASTROESOPHAGEAL REFLUX DISEASE (GERD): INDICATIONS AND PREOPERATIVE PROTOCOLS

Abstract

Gastroesophageal Reflux Disease (GERD) is a prevalent chronic condition. Although clinical treatment with Proton Pump Inhibitors (PPIs) is the initial basis, it is estimated that up to 40% of patients present with refractory symptoms. For this group, surgical management, predominantly performed through Laparoscopic Antireflux Fundoplication (LARS), represents an effective alternative to restore the competence of the esophagogastric junction. However, the success of the intervention depends on a rigorous selection of candidates and a comprehensive preoperative protocol. This protocol requires objective confirmation of GERD and exclusion of differential diagnoses, with Upper Digestive Endoscopy (EGD), High-Resolution Esophageal Manometry (to assess motility and guide the surgical technique), and 24-hour esophageal pH-Impedance monitoring (gold standard for documenting pathological reflux, especially in refractory or extraesophageal cases) being indispensable. LARS provides significant symptomatic relief in appropriately selected patients, reinforcing that the integration of clinical data and functional examinations is the cornerstone for a safe and effective surgical indication.