What is fundoplication? Fundoplication is a surgical treatment for gastroesophageal reflux disease. In this procedure, the fundus, which is located on the left side of the esophagus, is flipped from the back of the esophagus to the right side of the esophagus up to the front of the esophagus, so that the fundic tissue wraps around the esophagus like a ring and acts as a flap. This allows food to enter the stomach from the esophagus during feeding, but prevents acid from returning from the stomach to the esophagus, thus resisting gastroesophageal reflux. What is gastroesophageal reflux disease? Gastroesophageal reflux disease is the abnormal reflux of gastric contents into the esophagus due to the absence of an anti-reflux barrier. Gastroesophageal reflux disease is mainly due to lower esophageal sphincter insufficiency or reduced peristalsis of the stomach and esophagus resulting in impaired gastric emptying. How to treat gastroesophageal reflux disease? The first choice of treatment for GERD is medication. With acid control medication, 90% of patients can control their symptoms, but when the medication is stopped for a year, 80% of patients will relapse. Gastroesophageal reflux disease is therefore considered a chronic disease, and many patients require lifelong medication. When medication fails, the Nissen fundoplication is a safe and effective treatment for GERD. Surgery is also often required for some severe esophageal lesions due to GERD. What is surgical treatment for GERD? Nissen fundoplication is the most common surgical procedure in cases of normal esophageal peristaltic function. This procedure can be done either through the traditional open approach or through a laparoscopic procedure. The open approach requires a large incision from the subxiphoid to the umbilicus, whereas laparoscopic surgery can be done with several small incisions of 5-10 mm. The specifics of completing fundoplication are essentially the same for both open and laparoscopic procedures. What are the advantages of laparoscopic fundoplication? Less postoperative pain; faster postoperative recovery; shorter hospital stay; lower incidence of postoperative complications such as infection, adhesions, hernias, etc.; faster return to normal work and less financial burden in those who are still working. Is the procedure safe for obese patients? Theoretically, laparoscopic surgery is more suitable for obese patients because there is relatively little effect of body size during laparoscopic surgery, whereas open surgery in obese patients requires larger incisions, more sutures, more intraoperative bleeding and more postoperative pain. Are all patients suitable for laparoscopic fundoplication? No. Laparoscopic surgery is not indicated for patients with severe cardiopulmonary disease already before surgery, who cannot tolerate general anesthesia and pneumoperitoneum, and for those with a history of major upper abdominal surgery, who may have severe adhesions. It is also more difficult to complete laparoscopic surgery. For most patients, laparoscopic surgery does not increase the risk of surgery.