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Surgical Procedures for Gastroesophageal Reflux Disease (GERD)

Surgery is reserved for severe cases of GERD, or those who do not respond to other treatments. Some people will be able to stop taking medications after surgery. Others may need less medication, or may experience significant relief from other symptoms of GERD.

Fundoplication

Fundoplication is the most common surgical procedure used to treat GERD. The procedure wraps the upper portion of the stomach around the area where the stomach and esophagus meet. The wrapped stomach applies pressure on the lower esophageal sphincter (LES) which helps keep the sphincter closed when needed.

If a hiatal hernia is present it may be fixed during this procedure. A hiatal hernia, when a portion of the stomach pokes through the diaphragm and into the chest cavity, increases the severity of GERD.

Fundoplication

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There are 2 methods used to perform a fundoplication:

  • Nissen fundoplication—An open incision in the abdomen will allow the doctor to directly see and operate on the stomach.
  • Laparoscopic procedure—Small incisions are used to pass small surgical tools into the abdomen to complete the surgery. The surgeon will view the area on a screen with images from a small video tool inserted into the abdomen.

Recovery is generally shorter with laparoscopic procedure than open surgeries but may not be appropriate for every situation.

Endoscopic Antireflux Procedures

A more recently developed method to treat GERD uses endoscopy. The endoscope is passed through the mouth and down the esophagus to reach the first part of the stomach. Through the endoscope, a variety of procedures can be done to decrease the backward flow of stomach acid into the esophagus. One example is transoral incisionless fundoplication (TIF). With TIF, fasteners are used to reshape the upper part of the stomach, tightening the LES muscle.

There are fewer risks and shorter recovery times associated with endoscopic surgery than open or laparoscopic surgeries.

LINX Reflux Management System

LINX is a small band with magnetic beads made from titanium. Laparoscopic surgery is used to place the band around the end of the esophagus where it meets the stomach. This band helps support LES function. When the LES should be closed, the magnetic beads are attracted together. Pressure from swallowed food or drink pushes the beads apart, allowing entry into the stomach.

References:

About TIF. GERDHelp website. Available at:
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Accessed March 2, 2015.
Gastroesophageal reflux disease (GERD). EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated April 11, 2016. Accessed October 4, 2016.
Gastroesophageal reflux disease (heartburn). Ohio State University Medical Center website. Available at: https://wexnermedical.osu.edu/digestive-diseases/heartburn. Accessed March 2, 2015.
Last reviewed June 2016 by Daus Mahnke, MD
Last Updated: 5/20/2015

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