Medical therapy, consisting of anti-acid medications and lifestyle modifications, results in symptomatic relief for most patients. Surgical therapy is indicated for patients in whom medicine has proven ineffective, is poorly tolerated, or is too expensive to continue. It is also indicated for complications of reflux disease such as an esophageal stricture (narrowing) and the development of pre-cancerous changes in the esophagus.
For those patients in whom a medical regimen has not been successful, anti-reflux surgery can offer gratifying, durable results with relief of GERD. While GERD can have several causes, surgery is most effective for those patients whose GERD is caused by a defective lower esophageal sphincter (LES), the muscle connecting the esophagus with the stomach.
Both surgical and endoscopic techniques are available depending upon the patient's specific case. Our gastrointestinal specialists were among the first to perform endoscopic suturing for gastroesophageal reflux and continue to evaluate its efficacy. They are actively testing new endoscopic devices. These minimally invasive procedures may enable the patient to return home the same day.
More than 90% of patients who undergo fundoplication have no reflux after surgery. The goal of the procedure is to restore the physiologic equivalent of the LES by wrapping the stomach around the lower esophagus.
As the stomach becomes distended during a meal, the wrap compresses the lower esophagus, preventing reflux, thus imitating the action of a valve. Hiatal hernia, if present, may be repaired during the procedure. For patients who have other problems contributing to or accompanying their GERD, such as a swallowing disorder, a shortened esophagus, or gastric outlet obstruction, there are variations to this surgery so that there is a better overall control of symptoms.
During the operation, the surgeon raises the liver to expose the junction between the stomach and the esophagus. A space is created behind the esophagus and the fundus of the stomach and freed from its attachment to the spleen. The fundus is then pulled behind the esophagus and secured in place. Depending on the type of procedure, the wrap is either sutured to the esophagus itself, or it is sutured to the stomach on the other side of the wrap.
Endoscopic Repair of GERD
Instruments and a small camera are inserted through the mouth and advanced to the junction between the esophagus and the stomach, where the stomach is tacked alongside the esophagus in order to create a more effective barrier to reflux. The surgeon performs the procedure entirely through the mouth without making any external or internal incisions. Read more here about the totally incisionless procedure now offered at NYP/Columbia.
This procedure is ideal for patients who:
- Have a positive pH test
- Are at least partially responsive to proton pump inhibitor medicines (PPIs)
- Who have significant non-acid regurgitation
- Who prefer to be off medication