Question

What is the role of surgery in acid reflux disease? How successful is it?

Answer

Gastroesophageal reflux disease (GERD) is caused by stomach acid refluxing up into the esophagus and causing damage there. It occurs because the valve (sphincter) separating these organs tends to relax inappropriately and thus allows back-flow of stomach acid into the esophagus. The most common therapy for GERD is suppression of stomach acid production with medications such as omeprazole Prilosec). These types of medications are known as proton-pump inhibitors or PPI's. Over 90% of patients with GERD will respond to treatment with PPI's.

Many people with GERD do not want to take these drugs indefinitely. We know that GERD is a chronic disorder which usually requires lengthy treatment, often for the rest of your life. One option for such patients is a surgical repair of their reflux. This procedure is called a 'fundoplication'. The procedure involves taking the upper stomach and surgically sewing it around the lower esophagus to improve the pressure in the sphincter. This procedure was done for years via a standard long abdominal incision. Post-operative recovery was often prolonged. In recent years fundoplication has been increasingly done via a laparoscopic approach (i.e. using very small incision or incisions and elongated instruments designed to be manipulated with the aid of a 'telescope'). This decreases the operative risk and shortens the recovery time. The laparoscopic approach is now a standard procedure.

Fundoplication, when done by an experienced surgeon, is extremely effective in eliminating reflux. Published studies claim 90% improvement rates, similar to those with PPI therapy. Its effectiveness is roughly the same with both the abdominal incision and laparoscopy approaches.

Keep in mind that this is an elective procedure and there are still certain risks inherent to any operation. Discuss your options with your physician.

Links

• GERD or GORD - It's Still a Pain