Foregut Surgery: Innovations and Reoperative Techniques.

This article reviews current and emerging surgical and endoscopic approaches to foregut disease, building on more than a century of innovation. For GERD, laparoscopic fundoplication remains the gold standard, complemented by magnetic sphincter augmentation, the novel RefluxStop device, and endoscopic options such as TIF, Stretta, and antireflux mucosectomy. In achalasia and motility disorders, laparoscopic and robotic Heller myotomies are equivalent, while POEM offers a noninferior endoscopic alternative limited mainly by postprocedural reflux. Management of recurrent dysphagia and myotomy "blowout" is discussed. Finally, paraesophageal hernia repair principles, 2024 SAGES guidelines on mesh and fundoplication, and robotic versus laparoscopic outcomes are summarized.