Surgical Correction of Reflux Disease

Surgical Correction of Reflux Disease

What is GERD?

Gastroesophageal reflux disease (GERD) is very common in the United States, with up to 40% of Americans having symptoms monthly.  Gastroesophageal reflux is defined as the movement of contents within the stomach, mainly acid, upwards into the esophagus.  This causes heartburn, regurgitation and other problems.

The majority of patients with GERD are placed on acid-suppression medication.  The medications are safe and effective in eliminating symptoms in most people.  In a few, however, medication alone does not control symptoms.  It is these people who are usually considered for antireflux surgery.

Do I need surgery?

Normal anatomy has the esophagus and stomach merging where the chest and abdomen meet.  Their meeting point is a muscular ring called a sphincter.  The sphincter’s normal job is to maintain pressure so that stomach contents cannot pass upwards into the esophagus.  In some people, their sphincter has become loosened and no longer acts as a protective barrier between stomach and esophagus.  Antireflux surgery acts to retighten the sphincter between esophagus and stomach and reclaim the protective pressure barrier.

Your GI physician will help you to choose an experienced general surgeon, who performs the surgery.  The procedure is called a laparoscopic fundoplication.  Laparoscopic refers to making 4 small incisions on the abdomen surface through which the surgeon passes equipment.  Fundoplication refers to the internal repair work performed by your surgeon.  The upper portion of the stomach, called the fundus, is tightly wrapped around the bottom of the esophagus (wrapping is referred to as plicating) to recreate pressure in the same location the sphincter used to be.  Thus, fundoplication, or stomach wrapping, is performed.

Recovery is usually rapid, as the small skin incisions heal quickly and most patients return to work within two weeks.  Most patients are able to stop using their acid-suppression medication and remain symptom-free.

What are the possible complications of the surgery?

Complications of the procedure include an excessively tight stomach wrap that makes swallowing difficult.  This can usually be solved with a gentle stretch of the newly wrapped area during upper GI endoscopy.  Most patients lose the ability to vomit after a stomach wrap.

What other tests are necessary prior to surgery?

Prior to consideration for fundoplication, patients must undergo esophageal manometry, which is a test to measure esophageal pressures.  The esophagus uses squeezing pressure to move swallowed materials downwards.  If squeezing pressures prior to fundoplication are not adequate, tightening of the esophageal-stomach connection may make swallowing more difficult or impossible.

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