Central role of surgical management in the diagnosis and treatment of gastroesoph- ageal reflux disease and its indications decision-making framework
10.3760/cma.j.cn441530-20250916-00342
- VernacularTitle:外科治疗在胃食管反流病诊治中的核心价值及适应证决策框架
- Author:
Enmin HUANG
1
;
Zehui HOU
1
;
Ning MA
1
;
Shuang CHEN
1
;
Taicheng ZHOU
1
Author Information
1. 中山大学附属第六医院疝和腹壁外科 广东省结直肠盆底疾病研究重点实验室 广州市黄埔区中六生物医学创新研究院，广州 510655
- Publication Type:Journal Article
- Keywords:
Gastroesophageal reflux disease;
Curative intervention;
Stepwise evaluation;
Individualized surgical approach
- From:
Chinese Journal of Gastrointestinal Surgery
2025;28(10):1118-1122
- CountryChina
- Language:Chinese
-
Abstract:
The surgical management of gastroesophageal reflux disease (GERD) has completed a paradigm shift from symptomatic palliation to curative intervention. For high-risk patients with pathological acid exposure (AET>6%), progressive anatomical destruction (e.g., ≥2 cm hiatal hernia or Hill grade III/IV lesions), or those requiring interruption of carcinogenic progression (such as Barrett's esophagus with dysplasia), anti-reflux surgery provides superior long-term efficacy compared to pharmacotherapy. Surgical indications require a three-dimensional assessment integrating anatomical, functional, and risk factors: patients with dominant anatomical defects are recommended to undergo combined hernia repair and fundoplication (biological mesh reinforcement for recurrent hernias reduces recurrence rates to 16.7%); functionally decompensated groups require decision-making based on objective reflux metrics (e. g.,>75 reflux events/24 hours); special populations such as post-bariatric GERD should preferentially undergo Roux-en-Y gastric bypass (reflux control rate: 93%), while those with motility disorders (e. g., scleroderma) are suitable for partial fundoplication to mitigate dysphagia risk (OR=0.285). Precision decision-making is achieved through a stepwise evaluation pathway (endoscopy→pH-impedance monitoring→high-resolution manometry). Intraoperative strategies are individualized based on motility status: patients with normal esophageal motility undergo the Nissen procedure, the elderly or those with ineffective esophageal motility are prioritized for Toupet fundoplication for optimized long-term safety, and magnetic sphincter augmentationenables 96% of PPI-responsive but medication-averse patients to discontinue drug dependency. The core value of surgical intervention lies in simultaneously achieving anatomical restoration and functional reconstruction, along with blocking Barrett's esophageal carcinogenesis (OR=0.41). This dual mechanism signifies a fundamental transformation in GERD management strategy.
