Preoperative gastroenterological evaluation for anti-reflux surgery: strengthening surgeon-gastroenterologist collaboration and improving patient selection

Introduction: Gastroesophageal reflux disease (GERD) is a common condition characterized by heartburn and regurgitation, affecting up to 20% of the adult population in Western countries. While proton pump inhibitors (PPIs) effectively manage symptoms for many, about 30% of patients experience refractory symptoms, emphasizing the need for accurate diagnostic techniques and potential surgical interventions. This review discusses the integration of various diagnostic tools such as high-resolution manometry, impedance-pH monitoring, and endoscopic evaluations in preoperative assessments. These modalities help in confirming GERD, evaluating esophageal motility, and identifying conditions like Barrett’s esophagus, which are crucial for determining the appropriateness of anti-reflux surgery such as laparoscopic fundoplication. Through a comprehensive diagnostic approach, clinicians can enhance patient selection, optimize surgical outcomes, and manage the increasing prevalence of GERD effectively. Areas Covered: This review discusses the integration of various diagnostic tools such as high-resolution manometry, impedance-pH monitoring, and endoscopic evaluations in preoperative assessments. These modalities help in confirming GERD, evaluating esophageal anatomy and motility, which are crucial for determining the appropriateness of anti-reflux surgery such as laparoscopic fundoplication. Expert Opinion: GERD management is shifting toward a more precise, personalized approach, supported by advanced diagnostics like endoscopy, HRM, pH monitoring, and barium esophagography. Tailored interventions are guided by these tools, particularly in surgical decision-making. The integration of interdisciplinary training, emerging technologies, and patient-centered innovations, such as wearables and simulation-based learning, promises to enhance outcomes and improve long-term quality of life.