Treating Heartburn with Surgery
Often gastroesophogeal reflux disease (GERD) can be managed medically; however, 1.75 million sufferers of daily GERD do not respond to lifestyle changes or drug treatments and may require surgery.
Surgery to treat GERD is controversial. Newer studies are questioning whether surgery is better than medical therapy and if the procedure truly cures the condition.
When is surgery necessary?
- When medical or drug treatment has failed to control symptoms.
- When patients can't afford to or do not want to take medication to treat their symptoms.
- When regurgitation that develops from chronic GERD cannot be cured by other methods.
If left untreated, chronic GERD can cause long-term complications.
What is minimally invasive surgery?
Minimally invasive surgery is an alternative to traditional surgery, which usually requires long and deep incisions and a lengthy recovery period. Minimally invasive surgery, also known as endoscopy (or laparoscopy if performed in the abdomen), eliminates the need for large incisions.
Most minimally invasive procedures are performed endoscopically. An endoscope (or laparoscope) is a thin, telescope-like instrument with a miniature video camera and light source on the end, which transmits images to a video monitor. The surgeon watches the video screen to perform the procedure using special instruments that pass through small incisions in the patient's body.
What are the benefits of minimally invasive surgery?
- Smaller incisions, and therefore, little or no scarring
- Shortened hospital stay
- Less risk of infection or bleeding after surgery
- Faster recovery
- Less pain
- Faster return to normal activities
- Lower overall costs
What is laparoscopic antireflux surgery?
Laparoscopic antireflux surgery is a minimally-invasive procedure that corrects GERD by creating an improved valve mechanism at the bottom of the esophagus. To correct GERD, the surgeon wraps the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This creates a tight sphincter so that food will not reflux back into the esophagus.
Who is a candidate for laparoscopic antireflux surgery?
Patients who meet the following criteria are likely candidates for laparoscopic antireflux surgery.
- Have not had previous abdominal surgery
- Have small hiatal hernias without complications of GERD
- Have no history of bleeding disorders
- Are not pregnant
- Have no other underlying medical problems, such as heart or lung disease
Not all patients are candidates for laparoscopic surgery. More invasive procedures, such as laparotomy (requires opening the abdomen) and thoracotomy (opening the chest), may be necessary for some people. Talk to your doctor to see what's right for you.
Will laparoscopic surgery cure chronic heartburn?
Although more than 90% of patients undergoing this procedure are initially cured of chronic heartburn, experts aren't sure if this is a permanent cure. New devices and procedures are being studied to improve the benefit to those who are not able to find relief with medications.