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How to choose among fundoplication, magnetic sphincter augmentation or transoral incisionless fundoplication

Rabach, Lauren; Saad, Adham R.; Velanovich, Vic

Current Opinion in Gastroenterology: July 2019 - Volume 35 - Issue 4 - p 371–378
doi: 10.1097/MOG.0000000000000550
ESOPHAGUS: Edited by Stuart J. Spechler

Purpose of review To examine current trends and research in nonmedical approaches to the treatment of gastroesophageal reflux disease (GERD).

Recent findings Long-term studies of GERD patients treated with transoral incisionless fundoplication (TIF) have found that a large portion of patients resume proton pump inhibitor therapy. In patients with uncomplicated GERD, magnetic sphincter augmentation (MSA) shows excellent short-term results in both patient satisfaction and physiologic measures of GERD, with fewer postoperative side-effects than fundoplication, although dysphagia can be problematic.

Summary Fundoplication remains the standard of care for patients with GERD complicated by hiatal hernias more than 2 cm, Barrett's esophagus and/or grade C and D erosive esophagitis. For the patient with uncomplicated GERD, MSA appears to be a viable alternative that has greater technical standardization and fewer postoperative side-effects than fundoplication. TIF remains an option for patients with refractory GERD who refuse surgical intervention.

Division of General Surgery, University of South Florida, Tampa, Florida, USA

Correspondence to Vic Velanovich, Division of General Surgery, University of South Florida, 5 Tampa General Circle, Suite 740, Tampa, FL 33707, USA. Tel: +1 813 844 4005; fax: +1 813 844 1920; e-mail:

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