4.Surgical intervention

Surgical intervention is the last option if other therapeutic management fails to achieve satisfaction. Among several GERD surgeries, laparoscopic Nissen fundoplication has been the gold standard, because it intends to restore the function of the gastroesophageal barrier [32]. However, patients undergoing fundoplication are at risk for developing postoperative adverse events, such as bloating, dysphagia, and belching. One study showed that 62% of the GERD patients who had fundoplication surgery came back on PPI medication later [33]. Magnetic sphincter augmentation (MSA) can be an alternative procedure to replace fundoplication. MSA uses a necklace of titanium beads with magnetic cores that encircle the distal esophagus and thereby strengthen the LES function. Compared with fundoplication, MSA is less invasive, and has a shorter operation time, less gas bloat, and better ability to belch and vomit [34]. For obesity-related GERD patients, Roux-en-Y gastric bypass (RYGB) is recommended by the ACG to be the best option [35–37]. However, a Swedish cohort study reported that among 2454 participants who had undergone RYGB, 48.8% (95% CI, 46.8–51.0) had GERD recurrence within 2 years of the operation [38].
