Surgery to Treat Gastroesophageal Reflux Disease
Lifestyle measures and medications are so effective at controlling reflux symptoms that few people need to undergo surgery. When surgery to treat GERD is required, the most common procedure is Nissen fundoplication. It involves lifting a portion of the stomach and tightening it around the gastroesophageal junction to increase pressure in the lower esophageal sphincter and prevent reflux.
The procedure is typically performed using a laparoscope, an instrument that can be inserted through small incisions in the abdomen. Five small incisions are made in the abdomen, and the surgeon inserts a tiny camera and specialized instruments through the incisions to perform the procedure.
Nissen fundoplication is performed in a hospital. You will receive general anesthesia and need to stay in the hospital for one to three days and can return to work in two to three weeks. Serious complications are rare but can include an adverse reaction to the anesthesia, blood loss, infection, and injury to the esophagus, stomach, or spleen. More common complications are stomach bloating, difficulty swallowing, belching, and vomiting. These problems usually improve within one to three months.
Surgery reduces reflux symptoms in most people, but it does not always eliminate the symptoms. About a third of people who undergo Nissen fundoplication still require medication on a regular basis to control their symptoms.
A 2010 review of 32 studies on Nissen fundoplication and Toupet fundoplication (a partial version of Nissen fundoplication) found that Toupet fundoplication produced similar results to Nissen fundoplication but caused fewer side effects, such as dysphagia or gas bloating.
Furthermore, a fundoplication procedure called the transoral incisionless fundoplication (TIF) can be done without incisions by going through the esophagus while the patient is under general anesthesia using a tool called the EsophyX. TIF is less painful and requires less recovery time than a traditional Nissen fundoplication.
And yet another new procedure called magnetic sphincter augmentation uses magnets to create a small ring around the gastroesophageal sphincter to help increase its pressure. The device used is called the LINX Reflux Management System.
Endoscopic Procedures to Treat GERD
These procedures are performed during an upper endoscopy on an outpatient basis and do not require incisions, general anesthesia, or a hospital stay like surgery does. However, these procedures are relatively new and their long-term effectiveness is not yet fully known.
One of these procedures is called endoscopic gastroplication, and there are three types: the Bard EndoCinch system, the NDO Plicator, and the Stretta system. In the Bard EndoCinch procedure, a gastroenterologist places a pair of stitches in the upper stomach about a centimeter below the lower esophageal sphincter and pulls the stitches together to form a "pleat." Usually, two to four pleats are created.
By reducing the size of the opening between the stomach and esophagus, the pleats help prevent reflux of stomach contents into the esophagus.
A second procedure, full-thickness plication (or the NDO Plicator procedure), places a stitch in the gastroesophageal junction to prevent the reflux of acid into the esophagus. In the Stretta procedure, a doctor delivers radiofrequency energy to the far end of the esophagus as well as to the upper stomach, creating multiple burns in the tissue there. As the tissue heals, it contracts and narrows the esophagus, helping to reduce reflux. The procedure works moderately well, but serious side effects, including death, have been reported.