What is the primary surgical procedure performed to correct severe GERD symptoms?

Nissen fundoplication.

Surgical intervention for GERD is considered a measure of last resort, typically reserved for children whose severe symptoms have proven unresponsive even after aggressive medical management, or when there is a specific underlying anatomical defect contributing to the reflux. The main procedure utilized to anatomically correct severe GERD is known as the Nissen fundoplication. This complex operation involves surgically wrapping the upper portion of the stomach, called the fundus, partially around the lower end of the esophagus. This wrapping creates a reinforced barrier that effectively tightens the weakened lower esophageal sphincter (LES), thereby making it much more difficult for stomach contents to reflux back upward into the esophageal tube.