The Biological Conservative Reconstruction (BIOCORN) Procedure: Redefining Surgical Treatment of Gastroesophageal Reflux Disease (GERD) and Hiatal Hernia Through Anatomical Preservation.

Abstract

The Biological Conservative Reconstruction (BIOCORN) procedure is a laparoscopic, anatomically conservative approach for managing gastroesophageal reflux disease and hiatal hernia. Unlike traditional wrap-based surgeries, BICORN restores the native gastroesophageal junction and angle of His without creating a restrictive wrap, preserving physiological functions such as belching and vomiting. This narrative review synthesized evidence from multiple studies identified through a comprehensive literature search using systematic selection and independent, blinded review to minimize bias. Clinical data indicate that BICORN provides high patient satisfaction, durable symptom relief, and effective reflux control while minimizing common postoperative complications, including dysphagia, gas-bloat syndrome, and impaired gastric emptying. Reported hernia recurrence rates vary, emphasizing the importance of careful patient selection and meticulous surgical technique. Postoperative assessments suggest preserved esophageal physiology despite minimal changes in lower esophageal sphincter pressures, supporting the procedure's anatomical and functional approach. Despite these positive outcomes, gaps remain in long-term efficacy data, direct comparisons with traditional antireflux techniques, and criteria for optimal patient selection. Future research should focus on controlled studies, long-term outcomes, and patient-reported measures to define BICORN's role as a physiologically conservative surgical option. This review highlights BICORN as a promising approach for patients seeking effective reflux management while maintaining natural anatomy and function.