Acid reflux disease, also known as gastroesophageal reflux disease, or GERD, may be effectively treated with drugs in the short term, but according to a still-quoted study in the May 2006 issue of "Motility Online," up to 80 percent of patients experience a re-occurrence of symptoms within one year after stopping medication. When drug therapy and lifestyle changes fail to adequately resolve the problem, some patients may wish to consider surgery.
Why Surgery Is Needed
GERD occurs because of a damaged or weakened lower esophageal sphincter, or LES, which normally acts as a one-way valve between the esophagus and the stomach. For some, weakness of the LES may be hereditary, and obesity is a major contributing factor. When the LES can no longer contract tightly and block digestive acids from splashing into the esophagus from the stomach, surgery can repair it. Hiatal hernia -- the stomach bulging into the chest cavity through a hole in the diaphragm -- is frequently present in those with severe GERD, and this condition may also require surgical repair.
Who Should Have Surgery
There are several circumstances when surgery is considered appropriate. One of the most common is the inability of medications to control symptoms. Another related circumstance is the desire to be free of life-long dependence on GERD medications because of side effects, risks or expense. Patients diagnosed with complications from GERD such as Barrett esophagus -- a tissue abnormality that usually affects the lower esophagus -- are likely to benefit from surgery, as are those with GERD-induced esophageal structures that cause regurgitation. Those who suffer from asthma, hoarseness, cough, chest pain or aspiration may be candidates for surgery.
Surgical Repair of the LES
The most common surgery for GERD is the Nissen fundoplication. A fundoplication involves first repairing any hiatal hernia, then coiling the upper part of the abdomen around the lower end of the esophagus. This strengthens the LES, restoring its function as the “one-way valve” to prevent acid reflux. The surgery can be done laparoscopically -- a minimally invasive surgical technique utilizing small incisions and the insertion of a viewing tube. This shortens hospital stay and recovery time. The laparoscopic approach may not be appropriate for patients who are obese or who do not tolerate anesthesia well.
Surgical Risks and Complications
The Nissen fundoplication is performed under general anesthesia and usually takes an hour or less. Most patients spend no more than one night in the hospital and can go back to work within a few days. According to GI Motility online, the operation has over a 90 percent satisfaction rate at 5 years. Severe complications are rare, but some patients may experience postsurgical bloating, difficulty in swallowing or mild esophagitis, although these usually resolve within a few months.
Other Surgical Procedures
Depending on the individual circumstances, other less common surgical procedures may be applied. The Hill posterior gastropexy aims to realign the disjointed junction of the esophagus and the stomach by wrapping the stomach around the esophagus 180 degrees, as opposed to 360 degrees used in a complete fundoplication. The Collis gastroplasty addresses the problem of a shortened esophagus -- an occasional effect of GERD -- which must be lengthened to perform a fundoplication. This is accomplished by stretching the upper portion of the stomach into a tube.
The Linx Reflux Management System
A new device, the Linx Reflux Management System, has recently been approved by the Food and Drug Administration. A specially designed “bracelet of magnetic beads” is placed loosely around the esophagus, augmenting the damaged LES. As food passes, the magnetic beads separate allowing the food to pass into the stomach and then close, preventing reflux. The procedure takes approximately 30 minutes and patients return home the same day. According to the Society of American Gastrointestinal and Endoscopic Surgeons, as of 2015, "Currently available data demonstrates a reasonable assurance as to the efficacy of the LINX Reflux Management System."
Medical advisor: Jonathan E. Aviv, M.D., FACS
- Essentials of Gastroenterology; Shanthi V. Sitaraman and Lawrence S. Friedman, Eds.
- Gastroenterology: Efficacy of Transoral Fundoplication vs Omeprazole for Treatment of Regurgitation in a Randomized Controlled Trial
- Ohio State University Division of Thoracic Surgery: TIF (Transoral Incisionless Fundoplication)
- GI Motility online: Surgical Therapy for Gastroesophageal Reflux Disease
- Society of American Gastrointestinal and Endoscopic Surgeons: TAVAC Safety and Effectiveness Analysis: LINX Reflux Management System