Secrets for successful laparoscopic anti-reflux surgery: patients with Barrett’s esophagus

Barrett’s esophagus is a common condition resulting from gastroesophageal reflux with the potential for dysplastic and even neoplastic transformation. The mainstays of treatment of Barrett’s esophagus are control of reflux via medical therapy, namely PPIs, or anti-reflux surgery. Fundoplication provides excellent long-term reflux control and may provide the added benefit of preventing progression of dysplasia in those with Barrett’s esophagus. Furthermore, effective anti-reflux surgery may promote regression of already present dysplasia. The purpose of this article is to review the potential advantages of utilizing anti-reflux surgery over medical management by summarizing the available literature detailing the ability of anti-reflux to control reflux, possibly prevent cancer progression, and induce regression of dysplasia. Furthermore, we review some of the alterations that occur on a molecular level that may be promoting these beneficial changes post-fundoplication.