How is surgery done to treat GERD? Doctor: The cause of GERD is the weakness of the muscles in the lower esophagus. The surgery is done by folding a part of the stomach around the lower esophagus and wrapping the connection between the esophagus and the stomach from the outside to form an anti-reflux flap, thus increasing the pressure in the lower esophagus and achieving the anti-reflux effect. The surgery does not remove any part of the body, but rather reconstructs it with autologous tissue. Are there any other surgical procedures for GERD other than laparoscopic fundoplication? Drs: Laparoscopic fundoplication is now recognized worldwide as the gold standard for the treatment of GERD, except that depending on the patient’s condition, either a complete fundoplication or a partial fundoplication can be chosen. In patients with esophageal fissure combined with GERD, an esophageal fissure repair is also performed. The traditional open-chest and open-abdomen surgery is no longer used due to the high risk. This surgery requires an incision of 20-30 centimeters from the umbilicus to the upper abdomen, with bleeding of about two to three hundred milliliters, which is very risky, and the postoperative wound is very painful and requires at least two to three days of bed rest. Therefore, many patients were previously discouraged from the surgery and would not undergo it as a last resort, even if their reflux symptoms were already severe. Laparoscopic fundoplication generally uses the globally accepted five-hole method, with one small one-centimeter hole in the umbilicus, two in the upper abdomen, and one five-millimeter and one one-centimeter hole in both sides of the abdomen. The average bleeding volume of the patient is five to ten milliliters, and the body recovers relatively quickly after the operation. However, some people may doubt that the operation can be done well with laparoscopy, and that the operation in the stomach is the same as an open surgery. In fact, although the traditional open-chest and open-abdomen surgery has a large incision, the stomach-esophageal junction that needs to be treated cannot be seen even from the chest incision, nor from the abdominal incision, and it depends entirely on the touch of the hand. In contrast, laparoscopic surgery is performed by entering the scope from the umbilicus, which allows direct visualization of the stomach-esophagus junction and six to eight times magnification under the scope, allowing the surgeon to operate with a more precise view. Once the laparoscope reaches the surgical site, the operation is no different from an open procedure, in that the fundoplication is performed.