The primary "permanent" surgical solution for chronic GERD (gastroesophageal reflux disease) is fundoplication, most commonly the laparoscopic Nissen fundoplication. Other permanent options include implanting a magnetic device (LINX system) or undergoing bariatric surgery in specific cases.
Surgery for GERD
The goal of surgery for reflux disease is to strengthen the anti-reflux barrier. During a procedure known as a Nissen fundoplication, your surgeon wraps the upper part of your stomach around the lower esophagus. This enhances the anti-reflux barrier and can provide permanent relief from reflux.
Laparoscopic Nissen fundoplication is currently the 'gold-standard' for treating GERD in patients who don't respond completely to medications or can't take medications for another reason. Laparoscopic Nissen fundoplication is the most commonly performed antireflux procedure.
But doctors at NYU Langone may recommend surgery if GERD symptoms, such as heartburn, chest pain, and hoarseness, persist or if diagnostic tests show that GERD is caused by a hiatal hernia—a hole in the diaphragm that allows part of the stomach to enter the chest cavity.
Is a Nissen fundoplication major surgery? Yes. Although a Nissan fundoplication is usually performed by laparoscopic surgery it is major surgery and you will need to have a couple of weeks to recover.
For the first 1-2 weeks after surgery, you will be on a blenderized diet. If your surgeon feels that you are ready, you will add in soft foods the following week, and finally transition to a regular diet a week later (except for breads and solid meat).
Possible complications associated with laparoscopic Nissen fundoplication include: Bleeding at the surgical site. Difficulty swallowing (dysphagia) because your stomach is wrapped too high on your esophagus or wrapped too tightly. Difficulty belching.
Surgical correction of GERD is recommended in the following cases: Continued pain or symptoms despite maximum medical therapy. The presence of Barrett's esophagus. Recurrent stricture formation on medical therapy.
There is usually minimal pain associated with this operation. The abdomen will be sore as well as the small incision sites, and some patients have shoulder pain for the first day or two. The shoulder pain is caused by gas left in your abdomen during the operation.
Yes. A student with GER or GERD has a disability if their GER or GERD substantially limits one or more of their major life activities. GER or GERD can, for example, substantially limit the operation of the digestive system, which is a major bodily function and therefore a major life activity under Section 504.
Anti-reflux surgery is very effective for treating gastroesophageal reflux disease. Specialized esophageal surgeons at UChicago Medicine use minimally invasive techniques to recreate the damaged valve between the esophagus and stomach.
Proton pump inhibitors (PPIs).
PPIs lower the amount of acid your stomach makes. PPIs are better at treating GERD symptoms than H2 blockers, and they can heal the esophageal lining in most people with GERD. You can buy PPIs over the counter, or your doctor can prescribe one.
LINX Device (not available in Australia yet): A ring of tiny magnetic beads is wrapped around the junction of the stomach and oesophagus.
Patients who have experienced any of the following may not be eligible for the procedure: Difficulty swallowing. Hiatal hernia larger than 2 cm. Body mass index (BMI) greater than 35.
While both fundoplication and LINX provide effective GERD relief, the best choice depends on individual factors: Patients with a hiatal hernia or significant anatomical concerns may require fundoplication. Those looking for a less invasive, reversible option may prefer the LINX system.
Nissen Fundoplication – Most often done laparoscopically, this common procedure for GERD typically takes 60 to 90 minutes to perform and requires a one-night hospital stay. Most patients are able to return to work in two to four weeks. Following surgery, 90 to 95% of patients have good control of typical GERD symptoms.
The operation usually takes between 1-2 hours. You may wake up with a small tube in your nose – this drains the stomach to reduce the chance of you vomiting. You usually stay in hospital for 1 night and can go home once we are sure you are managing to drink enough, although you may be able to go home on the same day.
Fundoplication surgery reinforces the lower oesophageal sphincter's ability to prevent gastroesophageal reflux from occurring. The surgery involves wrapping the top part of the stomach (the fundus) around the lower end of the oesophagus and suturing it in place.
You may be a good candidate for surgery when:
Side effects of anti-reflux surgery are related to the creation of a valve at the lower esophageal sphincter where none previously existed. These may include: Difficult, painful swallowing that may last up to three months, but is usually gone in 4 to 6 weeks. It may be associated with pain in the shoulder as well.
Persistent symptoms – Heartburn occurring more than twice weekly requires medical evaluation. Severe complications – Difficulty swallowing, chest pain, or a chronic cough indicate serious GERD progression.
A TIF procedure is an endoscopic operation to treat chronic acid reflux (GERD) and hiatal hernia. “Endoscopic” means that it's done with the aid of an endoscope, a long tube with a camera that goes through your mouth into your esophagus. This is less invasive than surgery because there's no cutting.
Conclusions: The quality of life is good in patients with GERD after surgical treatment, both with total fundoplication and partial fundoplication, obtaining a low probability of presenting GERD in both surgeries with the GERDQ questionnaire, with similar percentages of 78.90% versus 75%.
Proton pump inhibitors are accepted as the most effective initial and maintenance treatment for GERD. Oral pantoprazole is a safe, well tolerated and effective initial and maintenance treatment for patients with nonerosive GERD or erosive esophagitis.
The TIF procedure is a minimally invasive alternative to traditional reflux surgeries like Nissen fundoplication. Unlike traditional surgeries that require abdominal incisions, the TIF procedure is performed transorally (through the mouth), eliminating the need for external incisions.