When Is Surgery for GERD Recommended?
Gastroesophageal reflux disease (GERD) surgery (antireflux surgery) is done when you have severe GERD symptoms like acid reflux that persist even after you use medicines and lifestyle changes. The following are the anti-reflux surgery indications:
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If you experience heartburn repeatedly, like twice a week.
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If you feel a sour or bitter taste in your mouth because of acid coming back to your throat or mouth.
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You may experience difficulty eating. This may be due to damage in the esophagus (food pipe).
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Suppose there is a dependency on medications. You may depend on medications for daily use, though there is no significant result.
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If pain persists even after taking medications.
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If an individual has untreated GERD, they may develop an inflammatory condition called Barrett’s esophagus.
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When developed with recurrent stricture (narrowing of the esophagus) while on medical therapy.
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If you develop a respiratory problem after absorption of stomach acid.
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Individuals who need medications for life can opt for surgery.
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Some individuals have trouble taking medications; they can go for surgery.
Persistent symptoms and certain complications of GERD may indicate the need for surgery. If people face failure of medications, and even lifestyle changes cannot control GERD symptoms, they can undergo surgery.
How Is GERD Diagnosed Before Considering Surgery?
Before a patient is considered for surgery, it is essential to clearly check that reflux is present. GERD can be diagnosed using the following tests:
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The 24-hour pH test:
In this test, a small and soft tube is inserted through your nose into the esophagus. This helps measure the amount of acid (pH) in the esophagus (food pipe). This test can measure pH in both the upper and lower esophagus. The inserted tube must remain in place for 24 hours. A shorter duration may not be sufficient to determine acid reflux. The inserted tube is connected to a box. This box is kept on your hip. Whenever a symptom appears, the button on the box is pushed. This helps us understand how symptoms are related to the acid present in the esophagus. This test, along with pH measurement, helps us determine when reflux occurs, how long it persists, and its severity. This information, together, helps to determine the composite score, known as the Demeester score.
A score of more than 14 is considered abnormal. Patients with severe acid reflux tend to have a score in the 200 range. Before undergoing this test, the patient should be instructed to discontinue anti-reflux medications for at least a week prior to the test, unless instructed otherwise by a physician. Once the test is done, they can restart the medications.
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Esophageal motility study:
This test helps measure the motion or contractions of the esophagus. It also measures the pressure it creates during contractions. This test helps determine the pressure and length of the lower esophageal sphincter (LES) and assesses how well the lower esophagus contracts. It also evaluates spam and high LES pressure (achalasia). This test is important for ruling out any esophageal disorders that may be present, as they can mimic reflux disease. This test is done in a similar way to a 24-hour pH test. The procedure takes only one to two hours to complete. A small tube is inserted through the nose into the esophagus. The pressure is measured in five sites (channels).
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Upper endoscopy:
In this procedure, a tiny camera is used to view the upper digestive system. The camera helps know about the inside of the esophagus and stomach.
It may not be effective when reflux is present, but it helps to know about the inflammation and other complications of the esophagus.
What Are the Benefits of GERD Surgery?
GERD surgery can help provide long-term relief from GERD symptoms. It also provides an overall improved quality of life. Other benefits of GERD surgery include:
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The risk of complications like Barrett’s esophagus or esophageal stricture may be reduced.
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The sleep quality of a person who underwent GERD surgery improves.
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The person may not feel discomfort while eating and drinking.
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After the GERD surgery, the person may have the lowest risk of developing esophageal cancer.
What Are the Surgical and Procedural Options for GERD Surgery?
If you are considering undergoing GERD surgery, you need to discuss many surgical options with your surgeon. These options typically involve correcting a hiatal hernia. This is because it is usually the most important issue to consider. These include:
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Laparoscopic fundoplication (LF):
This procedure is the most commonly performed surgery for GERD. It is an outpatient procedure that requires one and a half hours. This procedure requires general anesthesia. Four small incisions are made to insert a flexible tube with a camera into the abdomen. The surgeon wraps the fundus around the lower esophagus to form a valve between the stomach and the esophagus. This procedure helps strengthen the lower esophageal sphincter (LES). There are two variations in this procedure. In Nissen fundoplication, the part of the stomach is wrapped entirely around the lower part of the esophagus, and in Toupet fundoplication, a part of the stomach is wrapped around a part of the esophagus. Both these procedures are found to be effective. The surgeon decides which type is to be performed based on the diagnostic test results and your medical history.
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Magnetic sphincter augmentation (LINX):
The LINX reflux management system is a newer device option for GERD. This procedure is considered safe and the most effective surgical option. This surgery is performed using laparoscopy. Small incisions are made on the abdomen, and a flexible tube is inserted with a tiny camera. A small, ring-like, flexible band of magnetic beads is used around the esophagus just above the stomach. These are enclosed in titanium. The magnetic attraction between the beads placed helps in keeping the LES closed. This prevents the acid from flowing back into the esophagus. This allows surgeons to measure the esophagus and LINX system.
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Endoscopic options:
Transoral incisionless fundoplication (TIF) is a minimally invasive procedure. TIF is performed through the mouth and does not require any incisions. Your surgeon inserts the device through the mouth. Then gently advancing it down the throat and esophagus to the area where it meets the stomach, known as the gastroesophageal junction. Surgeons, with the help of a tiny camera present in the device, create sutures and fold them around the LES muscle. In this way, they tighten and repair the LES.
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Paraesophageal (large) hiatal hernia repair:
Hiatal hernia is performed along with a surgical procedure called LF. During LF, the surgeon pushes the top of the stomach back down below the diaphragm. Then, straighten the esophagus and close the hole in the diaphragm with sutures or, sometimes, with surgical mesh, ensuring that the stomach stays in place.
What Is the GERD Surgery Recovery Timeline?
The GERD surgery recovery depends on the surgical procedure.
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The GERD recovery timeline for LF is as little as a week.
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In the case of TIF, a person can start all activities a few days after the surgery.
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In the LINX management system, a person can be discharged on the same day of the surgical procedure. A few weeks may be needed for the esophagus to adjust to the ring. After this, swallowing may be normal.
Conclusion
GERD surgery is very important, especially when other means of treating GERD fail. Surgical procedures provide lasting results. These help manage severe GERD symptoms or complications like Barrett’s esophagus or stomach ulcers. Before performing surgery, careful assessment is crucial for the patient’s safety. Laparoscopic techniques involve smaller incisions, lower risks, and a faster recovery. These factors, along with long-term control of GERD symptoms, make these surgeries effective. For more information, you can consult a gastro health specialist online.
Key Takeaways
- GERD surgery is done when other treatments like medications and lifestyle changes fail to control GERD symptoms.
- There are various surgical procedures that a surgeon can opt for based on a patient's needs.
- GERD surgeries are more effective as they have fewer risks, smaller incisions, and faster recovery.
