Evolution in the treatment of gastroesophageal reflux disease
10.3760/cma.j.cn115396-20241112-00349
- VernacularTitle:胃食管反流病外科治疗的演变
- Author:
Feilong WENG
1
;
Haoran FEI
;
Xiaojun SHEN
;
Kekang SUN
Author Information
1. 江苏大学附属昆山医院胃肠外科，昆山 215300
- Keywords:
Gastroesophageal reflux;
Hernia, hiatal;
Surgical procedures, operative
- From:
International Journal of Surgery
2025;52(1):64-68
- CountryChina
- Language:Chinese
-
Abstract:
The surgical management of gastroesophageal reflux disease has evolved significantly with the increased understanding of the physiology of the reflux barrier. Initially, emphasis was on reduction of hiatal hernias and crural closure. With persistence of reflux symptoms, along with the development of esophageal manometry and the discovery of a high-pressure zone, focus evolved to surgical augmentation of the lower esophageal sphincter, including reconstruction of the angle of His, ensuring sufficient intra-abdominal esophageal length, fundoplication, and magnetic sphincter augmentation. More recently, the role of crural closure in antireflux and hiatal hernia repair has again received renewed attention due to the persistence of postoperative complications and recurrences. Rather than simply preventing transthoracic herniation of the fundoplication as was originally thought, crural closure has been documented to have a critical role in re-establishing intra-abdominal esophageal length and maintaining the pressure of LES. The application of mesh provides more options for strengthening crural closure. In this review, this article will discuss the evolution of surgical techniques for gastroesophageal reflux disease over the past century, aiming to better guide the surgical treatment and clinical research of gastroesophageal reflux disease.
