Surgical Treatment of GERD
More severe cases of heartburn and acid reflux may actually be a symptom of GERD. In these cases, surgery may be recommended.
About 25% of patients with reflux disease will develop progressive disease and complications such as hiatal hernia and Barrett’s esophagus. In these patients, surgical treatment should be considered.
In addition, surgery should be discussed with patients who:
- Continually regurgitate despite the reduction of acidity
- Have evidence of lung damage due to aspiration of fluid from the esophagus into the lungs
- Have intolerance to medications used for treating gastroesophageal reflux
- Respond well to these medications but do not want to continue taking them for the rest of their lives.
Goal of Surgical Treatment
The aim of surgical treatment is to restore the function of the lower esophageal sphincter (the valve between the esophagus and the stomach) and to prevent the reflux of acid and bile from the stomach into the esophagus. The most common procedure to restore the function of the lower esophageal sphincter is a minimally invasive procedure called laparoscopic Nissen fundoplication.
A laparoscopic fundoplication, performed through two small incisions in the abdomen, strengthens the valve between the esophagus and stomach by wrapping the fundus around the esophagus. This prevents stomach acid from backing up into the esophagus.
Transoral Incisionless Fundoplication (TIF)
Transoral Incisionless Fundoplication (TIF) is a unique form of Natural Orifice Surgery that treats the anatomical cause of GERD. Compared to conventional laparoscopic or open GERD surgery, patients undergoing the TIF procedure have shorter hospital stays, reduced discomfort, shorter recovery time, no visible scars from the procedure and higher overall satisfaction.
By inserting a scope through the mouth, a device is able to reconstruct the lower esophageal sphincter (LES) inside of the stomach. By recreating the LES, stomach acid is blocked from refluxing back into the esophagus. This effectively eliminates the sensation of heartburn and acid reflux. Because there are no incisions made during the TIF procedure, there are fewer complications, less pain and faster recovery time in comparison to other GERD surgeries. Even though an overnight hospital stay is still required for the TIF surgery, recovery from the surgery is short and relief from symptoms is immediate.