Antireflux Surgery Information

Gastroesophageal reflux disease or GERD affects millions of Americans. In most cases, the disease can be controlled with medical (drug) therapy. In more severe cases, however, medical therapy is not enough and antireflux surgery is necessary.

 

Why turn to surgery for GERD? When acid from the stomach refluxes into the esophagus it can cause a significant amount of pain (heartburn), a foul taste, and it can interfere with swallowing. The esophagus can become inflamed because of the constant exposure to stomach acid and lead to a condition known as reflux esophagitis. When acid is in the esophagus, it is more likely to be regurgitated and inhaled, leading to lung injury.

 

When the esophagus is repeatedly bathed in stomach acid it can lead to a more serious problem. The cells of the esophagus begin to change when they are exposed to acid over time. They become more like stomach cells than esophagus cells. These abnormal cells are much more likely to convert into esophageal cancer. Antireflux surgery is used to curb GERD symptoms and to prevent the esophagus from being permanently damaged, which can lead to cancer.

 

There are many types of antireflux surgery, but the most commonly performed procedure is the Nissen fundoplication. In a Nissen fundoplication, the surgeon wraps the top part of the stomach around the lowest part of the esophagus. Since the stomach is a muscular organ, it provides additional closure to the esophagus so that acid cannot reflux. This antireflux surgery also prevents the stomach from sliding above the lung diaphragm (a condition known as a hiatal hernia). Reports suggest that 92% of patients enjoy a resolution of their symptoms from this antireflux surgery.

 

 

A fundoplication surgery can be performed laparoscopically. Lapaorscopic antireflux surgery in this way lasts two to three hours and the hospital stay is about two days. This is a faster recovery than an open fundoplication, however the surgery is technically challenging. As a result, some surgeons opt for the open approach if there is a high likelihood of complications.

 

Other types of antireflux surgery include lengthening of the esophagus, changing the angle of the very first part of the stomach, and making the hole in the lung diaphragm smaller. They are performed less often than fundoplication. In general, these alternate surgical options are used in pediatric patients with severe, unrelenting gastroesophageal reflux disease. The goal of all of these antireflux surgery procedures is to physically prevent the hydrochloric acid that is formed in the stomach from entering the esophagus.

 

Antireflux surgery is associated with some complications. Because a cuff is made around the esophagus, patients report problems with swallowing (a disorder known as dysphagia). People that have had antireflux surgery also report bloating and cramping since swallowed gas is not as easily belched. Over time the stomach that has been wrapped around the esophagus may slip or become unwrapped. In fact, ten years after the antireflux surgery, more than half of all patients are back on antireflux or antacid medications. It is important to discuss the benefits and limitations of antireflux surgery with your gastroenterologist and surgeon before having any of these procedures.