Understand the principles of the most common anti-reflux procedures and the long-term outcomes associated with these. Principles of Common Anti-Reflux Procedures Nissen Fundoplication Principle: Involves the wrapping the fundus around the lower oesophagus -> reinforces the LES -> prevents acid from reflux. Indications: Patients with severe GERD -> especially patients who do not respond to medical therapy or have complications. Toupet/Partial Fundoplication Principle: 270 degrees wrapping of the stomach around the oesophagus. Less extensive that Nissen’s. Reduces reflux while minimizing the risk of post operative dysphagia. Indications: Patients with GERD who have oesophageal motility disorder as it exerts less pressure on the oesophagus. LINX device Principle: A ring of magnetic beads is placed around the LES -> magnetic attraction between the beads -> keeps LES closed -> but allows it to open for swallowing. Indications: Used for patients with GERD who prefer a less invasive procedure. Roux-en-Y Gastric Bypass Principle: Mainly used for weight loss. Can also be used for GERD. Creates a small stomach pouch and bypassing a portion of the small intestine -> reduces acid production and reflux. Indications: Obese patients with GERD who also need a weight reduction surgery. Long Term Outcomes Nissen Fundoplication Outcomes: Provides good long-term control of GERD. Some patients may experience post-operative complications. Such as: Dysphasia Gas bloating syndrome Inability to blench or vomit. Durability: Studies show a sustained reflux control with low rate of surgical revision. Some patients may require reoperation over tome. Toupet Fundoplication Outcomes: Similar to Nissen, but a lower incidence of post-operative dysphagia. Higher risk of recurrent reflux symptoms than Nissen. Durability: Significant symptom relief. Improved quality of life. LINK device Outcomes: Effective in reducing GERD symptoms. Fewer side effects than fundoplication. Patients report high satisfaction and improved quality of life. Durability: Sustained symptom control. Roux-en Gastric Bypass Outcomes: Highly effective at controlling GERD symptoms especially in obese patients. Has the added benefits of weight loss. Durability: Sustain symptom relief and weight management.