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Surgical Solutions for Acid Reflux

Learn about a new FDA Approved device that is changing the treatment of GERD >

Endoluminal treatments (non-invasive procedures performed via a flexible scope through the mouth) exist for GERD. Procedures such as Stretta, EndoCinch, Enteryx and the Plicator are approved by the FDA and initially have shown encouraging results. Because they are new, the long-term results are unclear.

At this time, the most clinically effective and proven treatment for severe or complicated GERD is surgery. Gastrointestinal surgeons have performed this surgery for more than 40 years. Recent innovative surgical techniques have allowed surgeons to perform this operation laparoscopically (use of very small incisions, special instruments, and a video camera).

What is LINX? 
LINX® is an implant device placed around the esophagus just above the stomach using a common, minimally invasive, surgical technique called laparoscopy. It is made of magnets connected by titanium wires, and the magnetic attraction between the beads is designed to help keep the weak LES closed to prevent reflux. Swallowing forces temporarily break the magnetic bond, allowing food and liquid to pass into the stomach. Magnetic attraction closes the LES after swallowing to reinforce the body's natural barrier to reflux. Patients are placed under general anesthesia during the procedure, which is generally completed in less than one hour. Once implanted, the device will begin working immediately. Meridian Surgery Center is the first surgery center in the country to offer this device. Learn more.

What is Laparoscopic Hill Repair? 
A Hill Repair restores normal anatomy through repairing the Hiatal Hernia and the weak anti-reflux valve (LES). The result is normal anatomy and normal function. Surgeons using the laparoscopic technique make five small incisions in order to perform the surgery. The Hill Repair has the longest published follow-up rate: 88 percent of patients have discontinued GERD medication and are satisfied 17 years after surgery. Most surgeons have no experience with the Hill Repair, but Dr. Wright has preformed more than 1,500 of these procedures.

What is a Laparoscopic Fundoplication? 
A Laparoscopic fundoplication is a surgical procedure in which a portion of the stomach (the fundus) is wrapped around the lower esophagus in order to prevent reflux of gastric acid and fluid into the esophagus. The benefits of this surgical approach include a rapid recovery, minimal time in the hospital (usually less than 24 hours), and very little pain and scarring. Surgeons perform laparoscopic fundoplication by inserting very small instruments through four to five very small (less than ½-inch) incisions, including a telescopic camera that connects to a TV monitor. Most patients are able to leave the hospital the day after their surgery is performed.
Even though both the open and laparoscopic procedures make the same internal changes, the open approach to this operation requires a much longer incision than the laparoscopic approach. This translates to a longer hospital stay, more discomfort, and a longer recuperation period.
The two most commonly performed Fundoplications are:

  • The Nissen Fundoplication–A complete (360 degree) wrap of the stomach around the esophagus
  • The Toupet Fundoplication–An incomplete (270 degree) wrap of the stomach around the esophagus

Your surgeon will determine which option is best for you based on the results of your testing. Most patients will undergo the Hill Repair because it seems to have the best results over the long-term. The top part of the stomach is wrapped around the esophagus, which forms a “valve” between the stomach and esophagus. This valve prevents acid from refluxing up into the esophagus, thereby greatly improving or preventing symptoms of GERD. In addition, the esophageal hiatus is narrowed with stitches and any hiatal hernia is repaired. The operation usually takes less than the hours to perform in routine cases.

Do I have to go to the hospital? 
Healthy patients can undergo outpatient laparoscopic anti-reflux surgery safely and at considerable cost savings. Meridian Surgery Center is a leader in this patient-friendly approach.

What can I expect from the surgery? 
Laparoscopic anti-reflux surgery has been shown to provide positive results in more than 90 percent of properly selected patients with GERD. In addition, recent evidence has shown that the operation can resolve much or all of the damage to the esophagus from the stomach acid of long-standing reflux. Most patients no longer require medication or have reflux symptoms following surgery.

What about robotic surgery? 
Dr. Wright performed the first robotic anti-reflux surgery in the state in 2010 and performs this in selected patients.

Are there any problems that can occur with surgery? 
The Laparoscopic fundoplication is a very safe and effective surgery, but all surgery does have some risk. It will be important that you choose a surgeon who has good training and experience with this procedure. Make sure to ask your surgeon how many procedures that he or she has done and what his or her results have been. In the hands of an experienced surgeon, the overall risk of serious complications is less than two percent.

Potential Complications of Surgery

  • Injury to an abdominal organ or to the bowel, stomach, or esophagus
  • Bleeding
  • Failure to completely relieve reflux symptoms
  • Difficulty swallowing
  • Inability to vomit
  • Diarrhea
  • Distended, painful stomach
  • Injury to the nerve that controls movement of the stomach

What should I do if I am interested in surgery to treat my GERD?

You should ask your primary care doctor, gastroenterologist, or family doctor for a referral to a surgeon who is trained and familiar with laparoscopic anti-reflux surgery. You and your surgeon will be able to determine the best approach for the treatment of your symptoms as well as the prevention of future problems that can develop with long-standing GERD.

 

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