Which procedure is primarily used to treat severe, persistent gastroesophageal reflux disease (GERD)?

Fundoplication is primarily used to treat severe, persistent gastroesophageal reflux disease (GERD) because it directly addresses the underlying mechanism of the condition. In GERD, acidic stomach contents frequently flow back into the esophagus due to a dysfunctional lower esophageal sphincter (LES). Fundoplication involves wrapping the top part of the stomach (the fundus) around the lower esophagus, which helps to reinforce the LES and prevent reflux. This procedure not only reduces the symptoms of GERD but also provides a long-term solution by creating a physical barrier against the backflow of stomach acid.

Other procedures listed, such as herniorrhaphy, cholecystectomy, or appendectomy, do not directly target the mechanisms involved in GERD. Herniorrhaphy is primarily used to repair hernias, cholecystectomy is the surgical removal of the gallbladder usually for gallstones, and appendectomy is the removal of the appendix typically due to appendicitis. None of these procedures are specifically designed to manage the reflux or esophageal issues associated with GERD, making fundoplication the appropriate choice for this condition.