Surgical treatment of gastroesophageal reflux disease in adults

C-TIF: concomitant transoral incisionless fundoplication; GERD: gastroesophageal reflux disease; MSA: magnetic sphincter augmentation; PPI: proton pump inhibitor; TIF: transoral incisionless fundoplication.

* Patients with mild ineffective esophageal motility on manometry may tolerate complete fundoplication, MSA, or TIF if not otherwise contraindicated.

¶ Patients who qualify for more than one procedure should choose one based on their values and preferences. Those who value resolution of reflux symptoms more than the risk of dysphagia or gas bloating should undergo a complete rather than partial fundoplication and vice versa. MSA has same efficacy as fundoplication but lacks long-term data on durability. TIF has not been compared with any other antireflux surgery in a randomized trial. Larger hiatal hernia can be repaired with c-TIF. Available local expertise and surgeon experience also factor into the decision making.