Gastroesophageal reflux disease (GERD) is a disease in which gastric contents flow back into the esophagus causing uncomfortable symptoms and/or complications. 1980s, the application of proton pump inhibitors (PPI) brought a breakthrough in the treatment of GERD, but with the increasing application of PPI, it was found that some patients could not be relieved or completely relieved after PPI treatment. Refractory GERD was thus born. In short, refractory GERD mainly refers to patients who have failed PPI treatment. But what kind of outcome is considered as PPI treatment failure? There is a lack of uniform understanding in the academic community on this point. Some scholars believe that PPI treatment failure refers to refractory GERD if the symptoms are not satisfactorily relieved after taking PPI once a day, while some scholars believe that PPI treatment failure is considered when the mucosal damage and reflux-related symptoms still occur after at least 12 weeks of double-dose PPI treatment for GERD; some domestic scholars propose that GERD patients with unsatisfactory results after 4 weeks of first-generation PPI treatment are considered refractory GERD. However, regardless of the criteria, patients with refractory GERD are those who are not satisfied with the effect of oral treatment with PPI drugs, i.e., patients whose clinical symptoms cannot be relieved by drug treatment alone. So what kind of treatment plan should be used for patients with refractory GERD? Currently, clinically, internal medicine is mainly used to optimize the combination of PPI medications by adjusting: H2 receptor antagonists, drugs to reduce the transient relaxation of the lower esophageal sphincter and pro-gastrointestinal motility drugs. However, long-term continuous oral administration of these drugs still does not guarantee patient compliance and treatment outcome. For these patients, surgical treatment becomes an option. The goal of GERD surgery is to enhance the anti-reflux effect of the lower esophageal sphincter, relieve symptoms, reduce the use of acid suppressants, and improve the quality of patient survival. One study claims that 88% of patients who fail PPI therapy are candidates for surgery. Complete symptom relief prior to surgery was reported in 82% of patients, and 94% were satisfied with the outcome of the procedure. The American College of Gastroenterology has also revised its guidelines for the treatment of GERD from “surgery should be considered only in cases where drug therapy has failed” to “for patients for whom long-term maintenance therapy is determined to be necessary. Patients. Reflux prevention surgery is a treatment option for patients who are determined to be on long-term maintenance therapy.