WHEN IS SURGERY NEEDED TO CORRECT ACID REFLUX?

Many of those suffering from acid reflux may have a more serious condition called gastroesophageal reflux disease or GERD as it is generically known. GERD is a digestive disorder caused by gastric acid flowing from the stomach into the esophagus.

Gastroesophageal refers to the stomach and esophagus, and reflux means to flow back or return, and gastroesophageal reflux is the return of acidic stomach juices, or food and fluids, back up into the esophagus. After food passes through the esophagus into the stomach, a muscular valve called the lower esophageal sphincter closes, preventing the movement of food or acid upward.

Gastroesophageal reflux occurs when the esophageal sphincter relaxes inappropriately, allowing acid from the stomach to flow backward into the esophagus. Heartburn, also called acid indigestion, is the most common symptom of GERD. However, if left untreated, gastroesophageal reflux can cause esophageal ulcers, esophageal bleeding and narrowing of the esophagus (peptic stricture).

In some cases, a hiatal hernia may be associated with GERD. When a hiatal hernia is associated with GERD, severe heartburn may result.

A hiatal hernia is caused by an opening in the diaphragm, a flat muscle that separates the chest from the abdomen, allowing a portion of the stomach to protrude into the chest. This condition can then cause the esophageal sphincter to fail. Although most cases of gastroesophageal reflux are caused by a weakened valve, there are other causes that need to be assessed by your doctor.

Once GERD has been identified, your doctor can prescribe a number of treatment options. Among these are lifestyle changes, such as weight reduction, avoiding certain types of food and taking medications to alleviate symptoms. Surgery may be an option when treatment with medications does not completely relieve the symptoms. Surgery is also a good option for patients whose symptoms are well controlled but want to eliminate the need for regular medication. And finally, patients with complications of reflux disease, such as ulcers, strictures or Barrett’s esophagus may consider the surgical option.

Surgical options

Anti-reflux operations (Nissen fundoplication) may help patients who have persistent symptoms despite medical treatment.

During the fundoplication surgery, the surgeon improves the natural barrier between the stomach and the esophagus by wrapping a part of the stomach known as the gastric fundus around the lower esophagus. This prevents the flow of acids from the stomach into the esophagus, and strengthens the valve between the esophagus and stomach, which stops acid from backing up into the esophagus as easily. This procedure is often done using a laparoscopic surgical technique – an advanced and more minimally invasive technique.

Who are good candidates for the procedure?

Surgical candidates are those whose heartburn is not well controlled with medicine, those who want to fix the problem without having to take medicine long term, and those who are having complications from reflux, including ulcers, strictures, hernias or Barrett’s esophagus.

What are the success rates for this surgery/procedure?

The success rate for the minimally invasive surgery is 90 to 95 percent for patients who have the typical symptoms of GERD, such as heartburn, regurgitation or belching.