The esophagus is a swallowing tube which connects the back of the throat with the stomach. A thickened area in the muscular wall of the lower esophagus acts as a one way valve, preventing reflux of gastric contents into the esophagus. The opening in the diaphragm through which the esophagus passes is usually just large enough for the esophagus to pass through. When the opening is larger than normal the upper stomach may rise up into the chest cavity, a condition usually referred to as a "hiatal hernia". When a hiatal hernia is present reflux does not necessarily occur unless the valve mechanism in the wall of the lower esophagus is defective. The contents of the stomach are very acid which can cause heartburn and ulcerations of the esophageal lining. After a period of time narrowing(stricture) of the esophagus and even cancer may result. The most common term for this sequence of events is gastroesophogeal reflux disease or GERD.

The primary treatment of GERD is medical, consisting of medications, alteration in eating habits and weight loss. When these measures fail surgery may be considered. The most common operation to treat this problem is called a Nissen fundoplication. Before the advent of laparoscopic techniques it was performed through a 10 inch incision in the upper abdomen and required hospitalization for about one week and one or two months away from work. The same operation can now be performed with a laparoscopic approach using 4 or 5 incisions, each less than half an inch in length to pass hollow tubes (trochars) into the abdominal cavity and perform the operation. This method has now become the standard surgical approach at the present time. Post operative pain is greatly reduced, and hospital stays average one or two days. Most patients return to work in one or two weeks.