What procedures help treat GERD?

Diana Meeks
Diana Meeks on behalf of Sigma Nursing
Family Practitioner

Usually, heartburn is not serious enough to require surgery, but people with the more serious gastroesophageal reflux disease (GERD) sometimes need surgery if other types of treatment are not enough to control the symptoms. People with chronic GERD also sometimes elect to have surgery rather than spend the rest of their lives experiencing discomfort and taking medication. The most common type of surgery used to treat GERD is called Nissen fundoplication. A surgeon wraps the top of the stomach around the lower esophageal sphincter (LES), which is the muscle that controls the flow of food from the esophagus to the stomach. The goal is to reinforce and strengthen the LES. This procedure requires a brief hospital stay followed by two to three weeks of recuperation at home. Other less common surgical techniques might be used to treat GERD. Sometimes a surgeon will use a thin tube called an endoscope to put sutures or stitches in the LES or to burn the LES, causing scar tissue to form. These procedures also are intended to reinforce and strengthen the LES, but they are considered more experimental than fundoplication because their long-term effects are still being investigated.

The most common gastroesophageal reflux disease (GERD) operations that have been done through the years include the Nissen and Toupet fundoplication. The Nissen uses the upper part of the left side of the stomach to support the valve (lower esophageal sphincter) by wrapping a liberated portion of the stomach 360 degrees around it.

This approach can be used when the pumping power of the esophagus (as determined by manometry) is strong. If the pumping power is weak the Nissen will offer too much resistance for food and liquid to pass into the stomach and food will stick (this is called dysphagia). Therefore a partial wrap called a Toupet fundoplication is used. Both these operations can be done with traditional open or minimally invasive approaches. Today, the minimally invasive route is the one most preferred. It uses small incisions with the assistance of a miniaturized camera, scope and small, thin instruments to complete the procedure. The advantage is less pain, less time in the hospital and faster return to normal activities. But, the operation calls on surgeons to have a great deal of expertise and experience to offer long-term success.

A revolutionary treatment option for GERD is the LINX Reflux Management System. LINX is a small, flexible ring of magnets placed around the lower esophageal sphincter during a minimally invasive procedure.

The strength of the magnets helps keep the weak lower esophageal sphincter closed to prevent reflux. Unlike the fundoplication procedures, LINX does not require alterations to the stomach that may limit future treatment options. Therefore, one day this may become the “first option” for surgical intervention for GERD.

The TIF procedure, the LINX procedure and the Nissen fundoplication are all used to tighten the esophogal sphincter.

Surgery should be considered in patients with well-documented reflux disease who cannot tolerate medications or continue to have regurgitation as a primary symptom. If symptoms persist despite medical treatment, a comprehensive evaluation should be completed prior to considering surgery. The surgery for treating reflux disease is known as fundoplication. In this procedure, a hiatal hernia, if present, is eliminated and part of the stomach is wrapped around the lower end of the esophagus to strengthen the barrier between the esophagus and the stomach. The operation is typically done via a laparoscope, an instrument that avoids a full incision of the stomach. Due to the complexity of this surgery, it is important to seek a skilled surgeon who has experience in performing this procedure and can discuss the risks and benefits of the procedure.

Stacy Wiegman, PharmD
Pharmacy Specialist

Surgery should only be considered for gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD) when medications and lifestyle changes have been tried and were unsuccessful. Fundoplication is usually the surgery for GERD or GER. During the procedure, the upper part of the stomach is tightened about the lower esophageal sphincter to prevent acid reflux.

Surgery is usually reserved for severe cases of gastroesophageal reflux disease (GERD) that haven't responded to other treatments. Antireflux surgery is a minimally invasive technique where a surgeon "reinforces" the lower esophageal sphincter (LES) area by wrapping the top part of the stomach around the lower part of the esophagus. Hiatal hernias (if present) are repaired during the procedure as well. The surgery has a 95 percent success rate for relieving GERD. About 5 percent to 20 percent of patients experience side effects or complications from antireflux surgery.

Medications, such as proton pump inhibitors and histamine blockers, treat GERD by lowering acid production in the stomach. However, they do not actually stop reflux. A surgical procedure, called fundoplication, can be done to correct the problem. To prevent reflux, the surgeon creates an artificial valve where the esophagus meets the stomach.

Surgery is a well-established treatment for gastroesophageal reflux disease (GERD) that has been shown in research trials to be as good as twice-daily medical therapy, if not better for long-term GERD management. Surgery may be the best option for those who don't want to take medications for the rest of their lives, as well as for those who have lifestyle restrictions such as limitation on diet or activity. Surgery is also likely the best option for those with more advanced GERD and who have hiatal hernia or Barrett's esophagus. Successful surgery does offer an advantage over using medications only. Additionally, the overall success rate of antireflux surgery is very high when done in a competent antireflux center. Approximately 80 percent of patients report good to excellent results after five years, and 90 percent report improved results. Ten percent will develop recurrent symptoms of reflux, and approximately five percent will need to undergo another operation.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.