IMPROVING THE TACTICS OF MINIMALLY INVASIVE SURGICAL TREATMENT OF PATIENTS WITH COMPLICATED FORMS OF REFLUX ESOPHAGITIS
Keywords:
Reflux Esophagitis, Complicated GERD, Laparoscopic Fundoplication, Minimally Invasive Surgery, Surgical Tactics, Hiatal Hernia Repair, Barrett's Esophagus, Nissen Fundoplication, Toupet Fundoplication, High-Resolution Manometry, Mesh Reinforcement, Foregut SurgeryAbstract
Reflux esophagitis, particularly in its complicated forms (Barrett's esophagus, strictures, grade C/D esophagitis), represents a significant therapeutic challenge where medical management often reaches its limits. While laparoscopic fundoplication has established itself as the gold standard surgical intervention for gastroesophageal reflux disease (GERD), its application in complicated cases requires nuanced modification and advanced technical strategy. This article critically examines the evolution of minimally invasive surgical tactics for this complex patient cohort. We analyze the shift from a one-size-fits-all fundoplication paradigm towards a tailored, pathophysiologically grounded approach. The article argues that improving outcomes in complicated reflux esophagitis hinges not merely on the execution of a minimally invasive procedure, but on the deliberate, evidence-based refinement of each tactical step—from patient selection and preoperative workup to the technical nuances of hiatus repair, fundoplication calibration, and the management of short esophagus. The ultimate goal is to achieve durable reflux control while minimizing postoperative dysphagia and recurrence, thereby elevating the standard of surgical care for this demanding condition
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