Surgical Procedures for Gastroesophageal Reflux Disease (GERD)/Heartburn
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Surgery is only performed in severe cases of GERD.

Fundoplication
Fundoplication is the surgical procedure used to treat gastroesophageal reflux disease (GERD). A hiatal hernia, if present, may also be fixed during this procedure. A hiatal hernia occurs when a portion of the stomach pokes through an opening in the diaphragm and into the chest cavity. This increases the severity of GERD.

Fundoplication

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There are two methods used to perform a fundoplication:

  • Nissen Fundoplication/Open Surgical Procedure
  • Laparoscopic Procedure
These procedures are performed with the patient under general anesthesia.

Nissen Fundoplication/Open Surgical Procedure
The surgeon makes a wide incision. This exposes the stomach and lower esophagus. The surgeon wraps the upper portion of the stomach around the esophagus. This creates pressure on the sphincter muscle at the bottom of the esophagus. If a hiatal hernia exists, the surgeon will also position the stomach back in the abdomen and narrow the opening in the diaphragm.

Laparoscopic Procedure
The doctor makes a small incision and inserts a laparoscope—a thin, flexible instrument with a light that allows the doctor to view the inside of the body on a view scope or on a screen. Gas is pumped into the abdomen to improve viewing. Other small incisions are made in the skin to allow for the insertion of surgical instruments. The doctor then wraps the stomach around the esophagus. If present, a hiatal hernia is repaired.

Each procedure takes several hours. The recovery period from an open procedure is usually about six weeks and about two weeks from a laparoscopic procedure. After successful surgery, some patients may be able to stop taking medication. Others may still require medication, but may need less or may experience significant relief from other symptoms of GERD.

Endoscopic Antireflux Procedures
A third, more recently developed method to treat GERD uses endoscopy. The doctor inserts a lighted device called an endoscope through the mouth and down the esophagus to reach the first part of the stomach. Through the endoscope, the doctor can perform one of a variety of procedures that decreases the backward flow of stomach acid into the esophagus, including transoral incisionless fundoplication (TIF). With TIF, a device, which has a camera on one end, uses fasteners to reshape the upper part of the stomach, tightening the sphincter muscle.

Since no incisions in the skin are necessary, endoscopic antireflux procedures generally take an hour or less and have a shorter recovery time; patients are able to return to work within a few days.




References:
EsophyX receives FDA clearance for performing transoral incisionless fundoplication surgery. Medical News Today website. Available at: http://www.medicalnewstoday.com/articles/83410.php. Published September 24, 2007. Accessed August 19, 2009.

Gastroesophageal reflux disease (GERD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated August 2009. Accessed August 8, 2009.

The Society of American Gastrointestinal and Endoscopic Surgeons website. Available at: http://www.sages.org. Accessed March 7, 2006.

The Society of Thoracic Surgeons website. Available at: http://www.ctsnet.org. Accessed March 7, 2006.

Transoral incisionless fundoplication with EsophyX. Endogastric Solutions website. Available at: http://www.endogastricsolutions.com/esophyx_for-pt.htm. Accessed August 19, 2009.

Treating GERD. Ohio State University Medical Center website. Available at: http://medicalcenter.osu.edu/patientcare/healthcare_services/digestive_disorders/gerd_heartburn/diagnosing_treating_gerd/treating_gerd/Pages/index.aspx. Accessed August 19, 2009.

Way L, Doherty G. Current Surgical Diagnosis and Treatment. 10th ed. New York, NY: Appleton and Lange; 1994.

Last Reviewed September 2012



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