Have you suffered from Heartburn, Acid Reflux or GERD? Â Have you considered Surgery to treat this symptoms? If the answer to any of these questions is yes then keep reading. Â In this post, I will be discussing some of the most current surgical options available to treat gastroesophageal reflux disease or better known as GERD. Â I have been performing anti-reflux surgery since 2006 and have treated hundreds of patients with a wide variety of upper gastrointestinal conditions including reflux, Hiatal or paraesophageal hernias, esophageal or gastric cancer, and many others. This post is for educational purposes only, it is not intended to replace a consultation with your local surgeon or medical provider. If you will like to discuss your particular situation in person please call my office and make an appointment.
How Common is GERD?
In the United States, approximately 40% of the population will experience heartburn or acid reflux at least once a month. Twenty percent once a week and 7% once a day. It is more common in elderly but younger patients can certainly experience acid reflux significantly enough to require medications or surgery.  Acid reflux cost Americans and health care approximately 6 billion a year.
Causes of GERD:
Acid reflux in most cases is a multifactorial condition. Â Diet is arguably the most common etiology for heartburn. Â Spicy food, highly seasoned food, pizza, chocolate, and sodas are commonly known to cause heartburn.
The timing of the meal is another well-known cause. Â Many patients will experience heartburn if they eat before going to bed. Â Other patients will only get the symptoms when getting off their usual daily routine. Â For example, let’s say you went on a trip to a different country or a different time zone and start eating meals that are not your usual, all these factors can precipitate the symptoms. Â Having said that, if you get symptoms only in special situations and require medication on an as-needed basis further treatment or diagnostic modalities might not be required. Â For those of you that get heartburn or acid reflux routinely please keep reading.
 Other acquired conditions can cause heartburn and acid reflux.  Hiatal hernias, paraesophageal hernias, esophageal dysmotility or lower esophageal sphincter (LES) dysfunction are some of them just to mention a few.
Long Term Complications of Acid Reflux:
When acid reflux is not treated or is inadequately treated long term complications can develop. Â Initially, the esophagus gets irritated with the persistent acidic environment causing what is called esophagitis. Â Continues damage can cause esophageal ulcers followed by strictures due to scar tissue. Â Barrett’s esophagus is another well known long term complication of chronic acid reflux. Â Barrett’s esophagus in simple terms is changes in the esophageal mucosa that mimics the stomach mucosa. Â The body interchanges these cells in order to protect the esophagus from chronic acid reflux. Â If acid reflux is not improved esophageal cancer can be developed. Â This is a topic for another post.
Diagnosis:
The history is the most important step in the diagnosis of acid reflux. Â As a surgeon not only you need to know the symptoms but also prior treatments, diagnostic studies if any, evidence of above mentioned long term complications or prior surgical interventions. Â Most patients when they come to see me have undergone an endoscopy or a contrast radiographic study. If the patient is been consider for acid reflux surgery a pH study and/or manometry is selectively obtained. In the video below I go into more details regarding these studies and why you might need them.
Treatment:
Medical therapy with acid suppression medications is usually the first line of treatment. Â Surgical intervention is reserved for patients with poor response to medications or young patients that don’t want to be taking medications daily for many years. Â Surgery is also indicated for patients that have significant side effects on medications.
Surgical Therapy for Acid Reflux:
A Laparoscopic Nissen Fundoplication is the surgical gold standard to treat acid reflux. This operation has been performed for many years and the results have been well documented in the surgical literature. The complication rate when done by a surgeon that is adequately trained is very low. Â Also, the mortality rate is less than 1% nationwide. Over 75% of the patients will be off medications at 10 years after surgery and 95% of the patients are highly satisfied with the surgery in long term studies.
Several modifications to a Nissen fundoplication exist but they are used in special situations. Â A Nissen fundoplication is a 360-degree wrap of the upper portion of the stomach around the esophagus to recreate the lower esophageal sphincter. Â The modifications to a Nissen mainly change the degrees of the wrap. A Toupet fundoplication is a 270-degree wrap and a Dor is a 180-degree wrap.
Robotic surgery is a similar approach to laparoscopic surgery but it has some minor differences.  I am fully trained to perform robotic surgery but in my hands, this approach doesn’t offer the patients any advantages.  Robotic surgery is more expensive than laparoscopic surgery, it takes longer to set up and it uses larger incisions than laparoscopic surgery.  The DaVinci Surgical System is a good tool for the surgeon that doesn’t have the skills to do this surgery laparoscopically with good results.
The LINX procedure is the new kid on the block for acid reflux surgery. It is a metallic ring made out of several magnetic beads that is placed around the lower esophageal sphincter in an attempt to recreate the normal sphincter function and control acid reflux. The device was FDA approved in 2012 and approximately 4000 cases have been performed worldwide. In a recent study, 87 % of the patients were off medications at 2 years. Â Ninety-four percent of the patients were highly satisfied with the procedure and 97% were on a regular diet.
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