When is GERD surgery necessary?
People with severe, chronic esophageal reflux may need surgery to correct gastroesophageal reflux disease (GERD) if their symptoms are not relieved by medications that reduce acid in the stomach, or by lifestyle changes, including losing weight, avoiding certain foods and quitting smoking.
If left untreated, chronic gastroesophageal reflux can cause complications such as esophagitis, esophageal ulcers, bleeding, scarring of the esophagus or Barrett’s esophagus.
Laparoscopic antireflux surgery is used in the treatment of GERD when medicines are not successful. Laparoscopic antireflux surgery is a minimally-invasive procedure that corrects gastroesophageal reflux by reducing the hiatal hernia, reconstructing the esophageal hiatus and reinforcing the lower esophageal sphincter.
Why is a second GERD surgery needed?
The majority of patients who undergo laparoscopic antireflux surgery to treat GERD are satisfied with the results and experience long-lasting symptom control and prevention of complications. However, some patients will have a recurrence of symptoms, or they may develop new symptoms that may require a second GERD surgery.
Symptoms that indicate a second surgery may be needed include:
- Persistent heartburn
- Difficulty swallowing (dysplasia)
- Abdominal discomfort
In some cases, the initial GERD surgery, which corrected the valve mechanism at the bottom of the esophagus, is no longer effective. For these patients, the created valve mechanism (called a fundoplication) may have slipped, herniated back into the chest, had been or has become too tight or twisted, causing the recurrence or worsening of their GERD symptoms or the development of new symptoms.
Recent research has shown that repeated laparoscopic antireflux surgery is an option for most patients and can be successful in improving their recurring GERD symptoms. Cleveland Clinic offers a multidisciplinary team with experienced thoracic surgeons to make certain that the best results are achieved for each patient.
Reoperative surgery is becoming an increasing proportion of our esophageal practice. The majority of esophageal reoperations are for failed antireflux procedures or unsuccessful interventions for achalasia.
What tests are needed to determine if a second surgery is necessary?
Pre-surgical evaluation is important to the success of laparoscopic antireflux surgery, for both initial and repeated operations. By completing thorough testing and screening of each patient’s medical history, the thoracic surgeon can plan the procedure to fit the patient’s needs.
Pre-surgical evaluation includes:
- A complete review of medical history and a physical examination
- Several tests to make sure you are physically ready for the surgery, including chest x-ray, blood test and electrocardiogram (EKG)
Barium swallow (esophagram)
A series of x-rays of the esophagus taken after the patient drinks a solution that contains barium. The barium coats and outlines the esophagus on the x-ray. Both the structure and function of the esophagus is assessed.
Esophagoscopy (esophagogastroduodenoscopy) with biopsy
A visual exam of the esophagus and stomach and removal of a sample of tissue of the upper digestive tract (biopsy) using an endoscope.
A diagnostic test that helps to determine the function of the esophagus.
If it is found that a second antireflux surgery is an option for you, the operation may be performed through an open abdominal incision or an incision on the left side of the chest. These larger operations require a hospital stay of at least several days.
- Iqbal A, Awad Z, Simkins J, Shah R, Haider M, Salinas V, Turaga K, Karu A, Mittal S, Filipi C. Repair of 104 Failed Anti-Reflux Operations. Annals of Surgery. 244(1):42-51, July 2006.
- Pessaux P, Arnaud J P, Delattre J-F, Meyer C, Baulieux J, Mosnier H; for the Association Française de Chirurgie. Laparoscopic Antireflux Surgery: Five-Year Results and Beyond in 1340 Patients. Arch Surg. 2005 Oct;140:946-951
- Spechler S J. The Management of Patients Who Have "Failed" Antireflux Surgery. Am Journal of Gastroenterology. 2004 March;99, Issue 3:552.
- Rice T W. Why Antireflux Surgery Fails. Digestive Diseases, 2000;18:43-47.
- The Society of Gastrointestinal and Endoscopic Surgeons. Laparoscopic antireflux surgery. (accessed 7/18/06)
- Society of Thoracic Surgeons, GERD.(accessed 8/15/06)