Proton pump inhibitor (PPI) is very effective in the initial treatment of
reflux esophagitis. However, the recurrence ratio is high during maintenance
therapy. Ten to 20% patients did not remained healed or the symptom were relapsed in spite of one year maintenance treatment with half or routine dose of PPI. Therefore, prolonged maintenance
therapy with PPI is needed for many patients with symptomatic
reflux esophagitis. On the other hand, surgical treatment is to repair functional disorder in defensive mechanism at esophagogastric junction which is main pathophysiology of
reflux esophagitis. Surgical treatment is radical treatment for
reflux esophagitis in this point of view. Nissen
fundoplication has become the most commonly used antireflux procedure. Following
fundoplication, 90% of the patients become symptom free in the long run. Laparoscopic Nissen
fundoplication is as effective as open Nissen
fundoplication in the short-term results. The average operation time is 2.5 hours, most of patients were discharged within two days after operation and lead to faster recovery from surgery than open procedure. Satisfaction rates ranged from 87 to 100%. Laparoscopic
fundoplication can be performed with less morbidity than open procedure. Therefore, laparoscopic Nissen
fundoplication is considered to be radical antireflux procedure. Compared to medical treatment, the life time costs of treatment are less with initial surgical management for men age 48 or below and women age 55 or below. The answer for "PPI or laparoscopic surgery in the treatment of
reflux esophagitis" is laparoscopic surgery definitely.