GERD results from gastric contents refluxing into the esophagus, causing symptoms such as heartburn, regurgitation, and dysphagia. The lower esophageal sphincter (LES) and crural diaphragm function as primary barriers to reflux. Contributing factors include transient LES relaxation, impaired motility, and increased intra-abdominal pressure. Chronic GERD can lead to complications such as esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma. [1,2]

Diagnosis is primarily clinical, supplemented by endoscopy, pH monitoring, and barium esophagography. While barium studies are useful for assessing hernias and motility disorders, they are not the primary diagnostic tool for GERD. [2]

Management includes lifestyle modifications, dietary adjustments, and proton pump inhibitors (PPIs) to reduce acid production. Surgery, particularly fundoplication, is indicated for patients with refractory GERD or complications. [1,2]

Fundoplication reinforces the anti-reflux barrier by wrapping the gastric fundus around the lower esophagus. The Nissen technique involves a 360° wrap, whereas the Toupet (270°) and Dor (180°) fundoplications provide partial wraps. [1] If a hiatal hernia is present, concurrent repair is necessary to prevent recurrence, typically involving diaphragmatic crural repair or gastropexy (stomach is sutured to the abdominal wall or diaphragm). [3] 

Laparoscopic fundoplication is the gold standard due to its safety, shorter recovery time, and lower incisional hernia rates. [1] However, failure occurs in 2-30% of cases, with reoperation rates around 2%, increasing in long-term follow-ups. [4,5]