Strategies and innovative practices of European minimally invasive surgery for gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a common esophageal disorder worldwide and can progress to erosive esophagitis, Barrett's esophagus, and even esophageal adenocarcinoma. Long-term use of proton pump inhibitors cannot fundamentally correct the functional impairment of the anti-reflux barrier, and symptom control is inadequate in approximately 40% of patients. Exploring individualized, standardized, and innovative anti-reflux surgical strategies is conducive to enhancing therapeutic efficacy and improving patient prognosis. Based on existing literature and European clinical practice experience, this article summarizes the key physiological basis of GERD, outlines classic anti-reflux surgical procedures, and reviews innovative lower esophageal sphincter (LES) augmentation techniques, including magnetic sphincter augmentation (LINX™) and the RefluxStop™ silicone implant. Regarding surgical strategy, hiatal hernia repair and LES augmentation remain core elements of anti-reflux surgery. Classic fundoplication remains reliable; however, its mechanical alteration can cause discomfort in some patients. LINX™ and RefluxStop™ offer advantages such as minimally invasive application and reversibility, effectively controlling reflux while reducing the risk of related adverse events. These novel implant technologies may progressively replace traditional fundoplication. Surgical intervention should adhere to the principle of shared decision-making to achieve individualized and precise treatment.