CONTROVERSIES

15. Is GERD better treated in the long term by PPI therapy or Nissen fundoplication?

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PPIs really work in resolving esophagitis and eliminating symptoms of GERD, but the long-term side effects are not fully known. Fundoplication potentially frees the patient from daily medicine (this has been challenged recently) and may cause morbidity in ≤ 10% of patients.

16. Should a Nissen fundoplication be performed by laparoscopy or laparotomy?

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The same procedure can be accomplished by either approach. Postoperative morbidity and mortality is comparable. The distinct advantages of laparoscopy are less postoperative pain, shorter hospitalization, and earlier return to work.

17. Can this disease be treated by other minimally invasive means?

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Yes. Other endoscopic methods include:

* Endoluminal suturing
* Radiofrequency treatment of the LES
* Injection of bulk-forming agents around the LES

References
WEB SITE
http://www.emedicine.com/med/topic857.htm
BIBLIOGRAPHY
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