Laparoscopic and thoracoscopic antireflux surgery.

Despite new effective drugs, like omeprazole, reducing gastric acid output and relieving gastro-oesophageal reflux disease (GERD) symptoms in most patients, there are still clear indications for surgical treatment of this chronic disease. The main indications are failure to control symptoms by medical treatment, noncompliance to medication and development of complications. Recent developments in minimal access surgery have modified the surgical approach to the treatment of GERD. The antireflux surgical procedures can be endoscopically performed reproducing all the essential component steps of the equivalent open operations, but with all the advantages of minimal access surgery. The fundoplication procedures are mainly performed laparoscopically and the thoracoscopic approach is chosen in patients with short oesophagus, morbid obesity or other contraindications to the laparoscopic approach. The short-term results of endoscopic antireflux surgery are at least as good than after open surgery. A review on the laparoscopic and thoracoscopic antireflux procedures is presented.