A Historical and Scientific Review of Anti-Reflux Surgery: Evolution, Evidence, and Future Directions

Gastroesophageal Reflux Disease (GERD) is a condition, which is frequently encountered by gastroenterologists, otorhinolaryngologists, surgeons and general physicians and requires a multidisciplinary treatment when there is a high symptom burden in patients. Besides lower oesophageal sphincter (LES) dysfunction there are several other risk factors that contribute to the development and symptoms (worsening) of GERD. While these lifestyle modifications and pharmacological therapies, particularly proton pump inhibitors (PPIs), are first-line treatments, a subset of patients requires surgical intervention due to refractory symptoms or complications. This review traces the evolution of anti-reflux surgery, examining its historical milestones, advancements, and future prospects. This review discusses the epidemiology of GERD, its pathophysiology, but also the development of Anti-Reflux Surgery (ARS). We will discuss the available evidence regarding different ARS procedures and will focus on individualised treatment for patients with GERD. In the treatment of patients with GERD we have to take into account that it might be challenging to personalise treatment and therefore optimise results. In this instance special considerations need to be taken for patients with GERD and obesity, patients with Barretts oesophagus, patients after bariatric and metabolic surgery (BMS) and patients with oesophageal motility disorders. Gastroesophageal Reflux Disease (GERD) is a condition, which is frequently encountered and requires a multidisciplinary treatment. Lifestyle modifications and pharmacological therapies are first-line treatments. Surgery is often required due to refractory symptoms or complications. In the treatment of patients with GERD we have to take into account that it might be challenging to personalise treatment and therefore optimise results. Special considerations need to be taken for patients with GERD and obesity, patients with Barretts oesophagus, patients after bariatric and metabolic surgery (BMS) and patients with oesophageal motility disorders.