Laparoscopic Partial Fundoplication

Gastroesophageal reflux disease (GERD) is an increasingly prevalent disease in today’s society. While many are adequately treated with acid-suppressing medications, a proportion of this population will be dissatisfied with their symptom control or will have side effects precluding them from taking acid-reducing medications. In this population, objective testing to substantiate the diagnosis of GERD including 24-h pH testing, EGD, and upper gastrointestinal (UGI) series is imperative to confirm the diagnosis. High-resolution esophageal manometry may also be indicated in those with dysphagia to help risk stratify chances for postoperative dysphagia and/or identify primary motility disorders of the esophagus. While there is no consensus in the literature, most would agree that the surgeon should at least consider a partial fundoplication in those patients with dysphagia and ineffective esophageal motility based on high-resolution esophageal manometry. This chapter describes indications, essential steps, variations, and complications of this procedure. It provides a detailed template operative note for the procedure.