Conclusion

Gastroesophageal reflux disease is one of the most common benign conditions of the upper gastrointestinal tract. A significant proportion of the population is affected on a long-term basis, often with a considerable impact on quality of life.

Initial treatment is conservative (dietary modification, elevation of the head of the bed, weight reduction, avoidance of nicotine and alcohol). In many cases, medical therapy is required. After discontinuation of medication, symptoms recur in a substantial number of patients. In such cases, the therapeutic options are either long-term treatment with PPIs or surgical intervention.

While medical therapy reduces acid production, alleviates symptoms, and often leads to healing of inflammatory changes in the esophagus, its effect is dependent on continued use.

Surgical approaches aim to provide long-term control of reflux by restoring the anatomical conditions at the gastroesophageal junction. Depending on the technique, either the barrier function is reinforced or the natural closure mechanism is reconstructed in a function-preserving manner.

In the modified BICORN procedure, the focus is on anatomical reconstruction. In addition to effective reflux control, natural functions such as belching and—if necessary—vomiting are generally preserved. This preservation of physiological function is a key determinant of postoperative quality of life.

Reflux disease is, in the vast majority of cases, mechanical in nature. From this perspective, purely medical therapy cannot correct the underlying cause. Surgical treatment therefore addresses the underlying cause by restoring the anatomical and functional conditions at the gastroesophageal junction.

Careful diagnostic evaluation, appropriate patient selection, and an individualized treatment strategy are essential. In experienced hands, this allows stable and reliable long-term outcomes.