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Even though the technical elements for a successful laparoscopic fundoplication have been clearly identified, 10–15 % of patients will eventually experience recurrence of their symptoms and between 3 and 6 % will need a second antireflux operation.

Esophageal diverticular disease is an uncommon entity for which appropriate treatment remains somewhat controversial. The acquired diverticulum is typically classified by its location (upper, middle, epiphrenic) and pathogenesis (traction, pulsion). Traction diverticula have been ascribed to inflammation and adhesions from periesophageal lymph nodes arising from, for example, pulmonary tuberculosis or histoplasmosis. Pulsion diverticula arise from a number of factors, most notably esophageal dysmotility, functional or mechanical distal esophageal obstruction, and focal weakness of the esophageal wall.

Gastroesophageal reflux disease is a common gastrointestinal condition. When medical therapy fails to adequately control symptoms, antireflux surgery is generally indicated. The most commonly performed antireflux operation is currently the laparoscopic Nissen fundoplication. During surgery, a consistent step-wise approach with attention to proper setup and common pitfalls can lead to good and durable clinical results with minimal long-term side effects.