surgical treatment of GERD

7-Surgical Intervention Anti-reflux surgery may be of benefit in children with con-firmed GERD who have failed medical therapy or who have life-threatening complications of GERD. Fundoplication reduces GERD by increasing the LES baseline pressure, de-creasing the frequency of TRLES, accentuating the angle of His, tightening the crura, and lengthening the intra-abdominal portion of the esophagus. However, it does not change any underlying esophagogastric dysmotility nor does it improve esophageal or gastric clearance time.[88,89] Given the reports of high short- and long-term failure and morbidity associated with surgery, thorough specialist evaluation by a pediatric gastro-enterologist should occur to ensure other possible explanations for clinical symptoms have been excluded and that medical therapy has been maximized prior to anti-reflux surgery.( Maclennan S, et al ,2010)