What are the two most common surgical techniques used to treat severe reflux in the United States?

What are the two most common surgical techniques used to treat severe reflux in the United States?

• A. Thal fundoplication and Nissen fundoplication (open or laparoscopic)
• B. Toupet fundoplication and Belsey repair
• C. MacDonald fundoplication and Dor procedure
• D. Heller myotomy and Nissen fundoplication

Answer: (A)

Fundoplication surgeries reinforce the lower esophageal sphincter by wrapping part of the stomach around the distal esophagus to prevent reflux. The two most common approaches in the United States are a full 360-degree Nissen fundoplication and a partial anterior Thal fundoplication. The Nissen wrap provides a strong barrier to reflux and has a long track record of effective control, and it can be done either through open surgery or more commonly by laparoscopy. The Thal wrap, a partial anterior wrap about 180 degrees, is chosen in patients where a full wrap might risk swallowing difficulties—such as those with weak esophageal motility—because it offers reflux control with a lower likelihood of postoperative dysphagia. Other options listed are either older techniques or targeted for different conditions (for example, Heller for achalasia) or are not as commonly used in routine GERD management as the pairing of Nissen and Thal.

Fundoplication surgeries reinforce the lower esophageal sphincter by wrapping part of the stomach around the distal esophagus to prevent reflux. The two most common approaches in the United States are a full 360-degree Nissen fundoplication and a partial anterior Thal fundoplication.

The Nissen wrap provides a strong barrier to reflux and has a long track record of effective control, and it can be done either through open surgery or more commonly by laparoscopy. The Thal wrap, a partial anterior wrap about 180 degrees, is chosen in patients where a full wrap might risk swallowing difficulties—such as those with weak esophageal motility—because it offers reflux control with a lower likelihood of postoperative dysphagia.

Other options listed are either older techniques or targeted for different conditions (for example, Heller for achalasia) or are not as commonly used in routine GERD management as the pairing of Nissen and Thal.