Anti-reflux surgery

Definition

Anti-reflux surgery is a treatment for acid reflux, also known as GERD (gastroesophageal reflux disease). GERD is a condition in which food or stomach acid come back up from your stomach into the esophagus. The esophagus is the tube from your mouth to the stomach.

Reflux often occurs if the muscles where the esophagus meets the stomach do not close tightly enough. A hiatal hernia can make GERD symptoms worse. It occurs when the stomach bulges through this opening into your chest.

Symptoms of reflux or heartburn are burning in the stomach that you may also feel in your throat or chest, burping or gas bubbles, or trouble swallowing food or fluids.

Alternative Names

Fundoplication; Nissen fundoplication; Belsey (Mark IV) fundoplication; Toupet fundoplication; Thal fundoplication; Hiatal hernia repair; Endoluminal fundoplication; Gastroesophageal reflux - surgery; GERD - surgery; Reflux - surgery; Hiatal hernia - surgery

Description

The most common procedure of this type is called fundoplication. In this surgery, your surgeon will:

Surgery is done while you are under general anesthesia, so you are asleep and pain-free. Surgery most often takes 2 to 3 hours. Your surgeon may choose from different techniques.

OPEN REPAIR

LAPAROSCOPIC REPAIR

ENDOLUMINAL FUNDOPLICATION

Why the Procedure Is Performed

Before surgery is considered, your health care provider will have you try:

Surgery to treat your heartburn or reflux symptoms may be recommended when:

Anti-reflux surgery is also used to treat a problem where part of your stomach is getting stuck in your chest or is twisted. This is called a para-esophageal hernia.

Risks

Risks of any anesthesia and surgery in general are:

Risks of this surgery are:

Before the Procedure

You may need the following tests:

Always tell your provider if:

Before your surgery:

On the day of your surgery:

Your provider will tell you when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

Most people who have laparoscopic surgery can leave the hospital within 1 to 3 days after the procedure. You may need a hospital stay of 2 to 6 days if you have open surgery. Most people can return to normal activities in 4 to 6 weeks.

Outlook (Prognosis)

Heartburn and other symptoms should improve after surgery. Some people still need to take drugs for heartburn after surgery.

You may need another surgery in the future if you develop new reflux symptoms or swallowing problems. This may happen if the stomach was wrapped around the esophagus too tightly, the wrap loosens, or a new hiatal hernia develops.

References

Falk GW, Katzka DA. Diseases of the espophagus. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 138.

Hunter JG, Kahrilas PJ, Bell RC, et al. Efficacy of transoral fundoplication vs omeprazole for treatment of regurgitation in a randomized controlled trial. Gastroenterology. 2015;148(2):324-333.e5. PMID: 25448925 www.ncbi.nlm.nih.gov/pubmed/25448925.

Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308-328. PMID: 23419381 www.ncbi.nlm.nih.gov/pubmed/23419381.

Petersen RP, Pellegrini CA, Oelschlager BK. Hiatal hernia and gastroesophageal reflux disease. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier; 2012:chap 42.

Richter JE, Friedenberg FK. Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 44.

Telem DA, Rattner DW. Gastroesophageal reflux disease. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 11th ed. Philadelphia, PA: Elsevier Saunders; 2014:9-14.