Laparoscopic treatment of bastro-esophageal reflux disease.

Gastro-esophageal reflux disease (GERD), with or without hiatal hernia, is the consequence of a functional disturbance of the lower sphincter of the esophagus. This dysfunction is more and more often seen in populations with Western eating habits. According to recent reports, 10 percent of the patients suffer from constant heartburn, 30 percent from discontinuous heartburn demanding active treatment. Finally, a great number of non-digestive symptoms, either pulmonary, E.N.T., or cardiac, are also connected with GERD. In the early 1970s, medical treatment was not very effective, hence the popularity of open surgery. Although the results were satisfactory, postoperative sequelae, in particular parietal ones, could not be avoided. The reason is that a large laparotomy is necessary to gain access to the esophageal hiatus, which always involves potential risks of postoperative incisional hernia.