Reflux: When should surgery become an option?

Surgery for acid reflux disease is only used when lifestyle changes and medications don’t work. Over the last several years traditional surgery has been replaced with minimally invasive procedures. This means that often surgery is done on an outpatient basis and recovery time is quicker and less painful. Surgery is often recommended when you have serious GERD symptoms.

The doctor will often recommend acid reflux surgery when you have ulcers and scar tissue on the esophagus and stomach. Scar tissue may result making it difficult to swallow. Surgery is usually a last resort when medications do not work. Sometimes it is used when patients do not want to take medications any longer. The doctor will help you find the best type of surgery for situation.

Fundoplication Standard Surgery

This is a standard surgical procedure for GERD. The surgeon makes a cut in the stomach to access the esophagus.  In this procedure part of the stomach is wrapped around the lower part of the esophagus. This is done to strengthen the sphincter muscle. This surgery can also be accomplished with laparoscopic surgery that uses smaller cuts and tiny instruments to make it less invasive. 

This traditional surgery has good long term results with patients. It requires a week recovery time in the hospital and six weeks before you are able to return to work.  The laparoscopic surgery only needs a few days in the hospital with patient able to return to work after a few days.

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This is an incisionless form of fundoplication surgery. It creates a barrier that stops stomach acid from coming through the esophagus.  A device is inserted through your mouth into the esophagus. It creates several folds in the base of the esophagus that creates new valves. It is designed for patients that do not want invasive surgery.

This procedure is performed under general anaesthesia. It is performed inside the stomach so there are no abdominal incisions. It is a new procedure that has helped patients in reducing symptoms and the need to take medications. Patients recover more quickly and experience less pain. It is not recommended for patients with large hiatal hernias.

Stretta

This procedure is performed with an endoscope. It is done on an outpatient basis A thin tube is threaded into your esophagus. An electrode at end of tube heats the esophagus and cuts into it. This forms scar tissue that blocks severe acid reflux. It strengthens the muscles around the esophagus. It has shown to be effective in relieving symptoms of acid reflux disease.

This procedure takes about 1 hour and patients return to normal activity in one day. A device with a catheter is inserted into the mouth and down the throat to reach the esophagus.  It treats the esophageal muscles with radio frequency waves that thickens and strengthens the muscle. After the procedure patients may experience some pain and a reduction of symptoms over the coming months. This acid reflux surgery has helped many patients reduce GERD symptoms over the last few years.

Linx Surgery

This uses a special device called a linx. This is a ring of magnetic titanium beads. It is wrapped around the esophagus to strengthen the sphincter muscle.  The beads are magnetized and keep the opening closed between the esophagus and stomach.  This allows food to pass through normally. It is minimally invasive surgery so recovery time is quicker.   Many patients stop taking medications after Linx surgery.

During Lynx surgery, patients are placed under sedation during the procedure. A linx measuring tool in inserted through the mouth down the throat into the esophagus to measure for the size of the linx needed opening. After it is measured the linx is lowered and put on using suture tails. They are aligned and make secure. Patients are able to return to daily tasks in a few days.

Tests to Determine Whether Surgery is Appropriate

An upper endoscopy is a procedure that places a small camera through mouth and down the throat to look at the esophagus, stomach and intestine. The patient is under mild sedation as an outpatient. The device is used to look for damage to the esophagus and stomach for acid reflux.  They look for scar tissue, ulcers, and infections. 

A ph. test uses a Cather inserted through the nose and into the esophagus.  It is performed in 24 hours and determines the presence of acid reflux. It is connected to a recording device and the patient monitors what they ate and drank and acid reflux occurrences.  The information allows doctors to monitor test results and provide treatment options.

Other tests used to test for GERD and severe acid reflux are a biopsy, esphogauel manometry, barium swallow and radiograph. Your doctor will run tests to determine if surgery is right for your and what procedure will help you recover from the symptoms you suffer from.  Surgery is an option when lifestyle changes and medications do not work. 

By Joan Russell

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