It is estimated 10 percent of gastroesophageal reflux disease (GERD) patients fail medical therapy. To determine if surgery should be considered, it is essential to have a proper evaluation to see if you are a good candidate.
There are four common tests to help identify whether anti-reflux surgery is right for you:
- Barium esophagram
- Upper endoscopy
- Esophageal manometry
- 24-hour pH monitoring
Anti-reflux surgery is becoming more common today with new minimally invasive techniques such as the laparoscopic Nissen Fundoplication.
Current Indications For Surgery Include:
- Symptoms and signs not responding to medical therapy
- Severe esophagitis
- Esophageal stricture (hiatal hernia, young patients who are unable or unwilling to maintain lifelong acid suppression)
The goal of surgery is to restore lower esophageal sphincter function to decrease the stomach and intestine contents from refluxing into the esophagus. It is also important in the surgery to keep a small amount of the esophagus in the abdominal cavity.
How Does Nissen Fundoplication Work?
In the laparoscopic Nissen Fundoplication, four to five incisions are made in the abdomen to insert a laparoscopic camera and small grasping instruments. These incisions are approximately two centimeters long.
The top of the stomach, called the fundus, is wrapped around the esophagus after being carefully dissected away from other abdominal tissue to prevent bleeding or injury. The stomach wrap helps to strengthen the lower esophageal sphincter to prevent reflux of stomach contents.
Patients are generally able to start a full liquid diet the day after surgery, which will be continued for two weeks after surgery to give the stomach time to heal. Patients will typically go home the day after surgery.
If the surgery is more complex, such as repairing a hiatal hernia as well as doing a laparoscopic Nissen Fundoplication, the patient may stay for a few nights in the hospital.
The incisions used during a Nissen Fundoplication procedure are small and heal quickly. The sutures are absorbable, eliminating the need for removal.
Potential complications from Nissen Fundoplication include dysphagia (difficulty swallowing) and gas bloat. These complications are less as surgeons continue to improve their techniques and understanding of how the stomach should be wrapped around the esophagus. The average rate of conversion from the minimally invasive laparoscopic approach to an open approach is approximately two percent. Of note, a reduction of esophageal cancer has not been shown with the use of anti-reflux surgery.