Surgery
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In addition to substituting for open surgery, minimally invasive surgery may lower thresholds for intervention and thus increase overall utilization rates. The degree to which laparoscopy may have lowered the threshold for elective anti-reflux surgery is unknown. ⋯ With the growth of minimally invasive surgery, rates of anti-reflux surgery have increased substantially, with wide regional variation in intervention rates. Further research is needed to determine the appropriate threshold for surgical treatment in patients with gastroesophageal reflux.