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Treating Heartburn with Surgery

Gastroesophageal reflux disease (GERD) can often be managed medically; however, surgery may be an option for some patients.

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 an option?

  • 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 (such as with a very large hiatal hernia)

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 laparoscopy, eliminates the need for large incisions.

Most minimally invasive procedures are performed laparoscopically. A 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 in a procedure called a fundoplication. This creates a tight sphincter so that food will not reflux back into the esophagus. Examples of these surgeries include Nissen fundoplication and Toupet fundoplication.

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. Many patients who undergo the surgery eventually return to the use of anti-reflux medications. New devices and procedures are being studied.

Endoscopic treatment of GERD

Some new techniques being developed include procedures performed at the time of upper endoscopy (also known as EGD) to change the lower esophageal sphincter. However, a statement from the American Gastroenterology Association in 2006 cautions that these treatments need further study, and "current data suggest that there are no definite indications for endoscopic therapy for GERD at this time."

© 1995-2009 The Cleveland Clinic Foundation. All rights reserved.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 11/12/2007...#9625

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