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Surgical Procedures for Gastroesophageal Reflux Disease (GERD)/Heartburn

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 still require medication, but may need less or may experience significant relief from other symptoms of GERD.

Fundoplication

Fundoplication is the most common surgical procedure used to treat gastroesophageal reflux disease (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
IMAGE
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There are two methods used to perform a fundoplication:

  • Nissen Fundoplication/Open Surgical Procedure—an incision in the skin 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 time associated with endoscopic surgery than open or laparoscopic surgeries.

LINX Reflux Management System

LINX is a small band with titanium, magnetic beads. A laparoscopic surgery is used to place the band around the end of the esophagus where it meets the stomach. This band helps to support the lower esophageal sphincter (LES). When the LES should be closed the magnetic beads are attracted together and help keep the esophagus closed. Pressure from swallowed food and drink pushes the beads pull apart and allows the food to pass into the stomach.

Revision Information

  • Reviewer: Daus Mahnke, MD
  • Review Date: 03/2014 -
  • Update Date: 03/02/2015 -
  • About TIF. GERDHelp website. Available at: http://www.gerdhelp.com/about-tif. Accessed March 2, 2015.

  • Gastroesophageal reflux disease (GERD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 19, 2015. Accessed March 2, 2015.

  • Gastroesophageal reflux disease (heartburn). Ohio State University Medical Center website. Available at: http://wexnermedical.osu.edu/patient-care/healthcare-services/digestive-diseases/heartburn. Accessed March 2, 2015.