Doctors may
recommend surgery if you have any of
these complications: Large hiatal hernia, Severe esophagitis,
especially with
bleeding, Recurrent narrowing (stricture) of the esophagus, Severe pulmonary
problems, such as bronchitis or pneumonia, due to acid reflux, GERD that is not
controllable by medication.Before 1991, a procedure called open Nissen
fundoplication was the surgery of choice for severe GERD. Today, doctors are
able to perform the same surgery with similar success laparoscopically —
through a few small abdominal incisions, instead of one large one. The
advantages of laparoscopic surgery are a shorter recovery time and less
discomfort. Nissen fundoplication involves tightening the lower esophageal
sphincter to prevent reflux by wrapping the very top of the stomach around the
outside of the lower esophagus. During laparoscopic surgery, a surgeon makes
three or four small incisions in the abdomen and inserts instruments, including
a flexible tube with a tiny camera, through the incisions. People who benefit
most from a Nissen fundoplication are those who gained relief from medications.
If you have minimal or no relief from medications, your doctor must be certain
that you have GERD before recommending surgery, which may mean additional
testing. Most people who undergo Nissen fundoplication remain free of GERD
symptoms for at least two years. For the majority of people, this benefit
extends to five years or more. You may still require medications for GERD, but
your GERD will likely be easier to control. Other surgical
procedures include
Toupet fundoplication, Hill repair and the Belsey Mark IV operation. All
involve restructuring the lower esophageal sphincter to improve its strength
and ability to prevent reflux. These surgeries are done less often, and their
success is often dependent on the skill of the surgeon. Complications from
surgery generally are mild, but may include difficulty swallowing, bloating and
diarrhea. These complications generally go away within one year. Newer,
less-invasive procedures: Your doctor may suggest a procedure for
tightening the lower esophageal sphincter. These procedures generally take less
time to perform, they don''t require any incisions, and you can go home the same
day. The procedures are performed endoscopically through a long, flexible tube
that''s inserted into your mouth and down your esophagus. These procedures are
recommended if you have a hiatal hernia or Barrett''s esophagus. EndoCinch
endoluminal gastroplication. This procedure uses a tool that''s like a
miniature sewing machine. It places pairs of stitches (sutures) in the stomach
near the weakened sphincter. The suturing material is then tied together,
creating barriers (plications) to prevent stomach acid from washing into your
esophagus. The barriers are located at and just below the junction of the
esophagus and stomach. The procedure may cause a sore throat or chest pain. The
long-term effectiveness of the procedure is still unknown. Stretta
procedure. This approach uses controlled radiofrequency energy to heat
and melt (coagulate) tissues within the portion of the esophagus that contains
the malfunctioning valve and at the junction of the esophagus and upper
stomach. The procedure appears to work by creating scar tissue and altering the
sensory nerves that respond to refluxed acid. The procedure may cause a sore
throat or chest pain. The long-term effectiveness of the procedure is still
unknown.