Gastroesophageal Reflux Disease (GERD) is a medical condition associated with acid reflux, heartburn, regurgitation, abdominal pain, coughing, bloating, and dysphagia (difficulty swallowing). Normally, food is swallowed and travels down the esophagus, a muscular tube that connects the mouth to the stomach. The food passes through a one way valve called the Lower Esophageal Sphincter (LES) into the stomach. The LES allows food to pass into the stomach and then closes to prevent the food from refluxing back into the esophagus. The majority of patients with GERD have a dysfunctional LES. The exact cause of this dysfunction is unknown. Chronic exposure of the esophagus to harmful stomach acids can cause inflammation, scarring, narrowing, and a change in the lining the esophagus called Barrett's Esophagus. Many patients with GERD may also have a hiatal hernia.
Procedure
There are three basic treatments for GERD. Patients with mild GER should modify their diet, loss weight, and avoid alcohol and tobacco. If symptoms persist despite these initial modifications, patients may be started on antacid medications to neutralize and decrease stomach acids to control symptoms and relieve esophageal inflammation. Medical treatment should be discussed with your physician.
Finally, anti-reflux surgery is the third option for the treatment of GERD. Patients whose symptoms do not respond well to medication or choose not to take lifelong antacid medication are candidates for surgery. Laparoscopic Anti-reflux surgery involves reinforcement of the dysfunctional LES. Five small incisions (all < 1 inch) are used as opposed to a large “open” operation which may require a large 10-12 inch midline incision.
A laparoscope is used as a camera to visualize and magnify the abdominal contents to monitors outside of the body. Long thin instruments are used to wrap the top of stomach around the lower portion of the esophagus to recreate and reinforce the dysfunctional LES. This is called a fundoplication or wrap. There are three different types of fundoplications, the Nissen Fundoplication, the Toupet Fundoplication, and the Dor Fundoplication. The Nissen Fundoplication is the most common and effective anti-reflux procedure.
Advantages of the Procedure
The advantages of laparoscopic anti-reflux surgery include a smaller incision, less pain, shorter hospital stay, lower chance of future hernia formation, and an earlier return to work and normal activities.
Recovery
A liquid diet is started the day after surgery and advanced to a soft diet as tolerated. Patients will need to continue on soft foods for approximately 2-4 weeks after surgery. Most patients spend one night in the hospital and are discharged home on the next day. Most patients return to work in less than one week depending on the physical requirements of their occupation. Patients return approximately two weeks after surgery for routine follow-up with their surgeon.