Historically, operative management for gastroesophageal reflux disease (GERD) has been directed towards restoration of anatomical and functional norms. Many publications describe excellent short-term outcomes following medical and surgical therapy. Unfortunately, few studies have addressed the long-term outcomes in children who suffer from GERD. As our understanding of GERD has grown more sophisticated, and as we begin to focus on long-term outcomes, we have begun to re-evaluate the indications for our operative management. Fortunately, our ability to evaluate outcomes has also grown more sophisticated, and as we are beginning to find that not all children benefit equally from anti-reflux procedures (ARP), long-term evaluation is helping to delineate various sub-populations of children with GERD that may benefit to a greater degree than others. Hopefully such studies will modify the algorithms by which we choose which children are likely to benefit, and by which interventions.

A proper understanding of the published work on long-term outcomes for antireflux procedures thus requires a thorough discussion and understanding of the underlying disease, the indications for operative intervention, the various technical options available to perform an anatomic repair, and our goals in doing so. All of these need also to be considered within the context of the history of the understanding of the diagnosis of GERD, as well as the advances in the technology available for repair.

Gastroesophageal reflux disease (GERD) is the abnormal reflux of gastric content proximally into the esophagus.