GERD Surgery

Commonly called heartburn or acid indigestion, GERD occurs when the contents of the stomach flow back up into the esophagus. This is generally due to weakness in or damage to the lower esophageal sphincter (LES). The LES should only let food pass from the esophagus into the stomach, not the other way around. When it does, the result is gastroesophageal reflux disease.

Millions of Americans suffer from GERD on a regular basis, and some cases are more extreme than others. There are many possible treatments, ranging from lifestyle modification to surgery. Surgical Associates of WNY offers comprehensive treatment for GERD.

Diagnosing GERD

Our patients receive a full gastrointestinal (GI) work-up, including:

1. Endoscopy: While the patient is sedated, a small camera mounted on the end of a lighted scope is inserted through the mouth and down into the esophagus so the surgeon can see how inflamed the esophageal lining is. This will allow the surgeon to determine the extent of the damage and the need, if any, for a biopsy.
2. Esophageal manometry: This test measures the pressure and strength of the contractions of the esophagus. This will tell the surgeon whether it’s functioning properly or in a diminished capacity.
3. pH testing: Known as the Bravo pH test, this monitors the acidity levels in the esophagus over the course of 48 hours. The surgeon will again use an endoscope to attach a small capsule to the lining of the esophagus. The patient wears a receiver to capture data from the capsule. The patient also uses the receiver to record episodes of heartburn.

These tests will provide a complete picture of your GERD and the damage it has caused to your esophagus and stomach lining. Once your surgeon has this insight, he will recommend the appropriate course of treatment.

First steps include adjusting diet and lifestyle. This may mean reducing or eliminating acidic foods, fatty and fried foods, alcohol, chocolate, and other triggers. Timing and spacing meals may also help. Patients often find some relief if they eat dinner at least two to three hours prior to bedtime, for example.

Medications such as antacids, H2 blockers, and proton pump inhibitors are also often used.

If these treatments alone aren’t enough, there are surgical solutions to GERD.

Surgical Options for GERD

Nissen Fundoplication

This procedure is effective when the cause of the problem is a weak LES. In a fundoplication, the upper portion of the stomach, the fundus, is wrapped around the lower esophagus and sewn into place. This means the esophagus will now pass through a tube of stomach muscle. The goal here is to provide additional muscle strength to this area. By reinforcing the sphincter with this extra muscle, the LES closes more completely and doesn’t allow for the backflow of stomach contents into the esophagus.

Paraesophageal Hernia repair

When a paraesophageal hernia occurs, it reduces the effectiveness of the LES, causing gastric contents to reflux. Repairing this hernia can bring relief from GERD symptoms.

LINX

This technology is providing relief for patients who have been unable to control their symptoms with medication or who are trying to avoid taking medication long-term. The LINX System is a small flexible band of interlinked titanium beads with magnetic cores. When you swallow, the force created by your esophageal muscle is enough to break the magnetic attraction between the beads and let the LINX band expand, thereby allowing food to pass into the stomach. It then contracts and closes the LES. There is no comparable muscle force associated with reflux. Therefore, the band won’t open to allow stomach contents back into the esophagus.

The LINX system looks like a small bracelet that is placed around the lower esophagus just above the stomach. This is done laparoscopically, meaning there is very little scarring, pain, and recovery time.

When you come in for a consultation with your surgeon, you can be sure he will take the time to study your specific symptoms and present you with the course of treatment that is best suited to you.

Learn more about the LINX System here.

Transoral Incisionless Fundoplication (TIF)

TIF is a minimally invasive fundoplication approach that is performed through the patient’s mouth and from within the patient’s stomach using no incisions. The incisionless EsophyX device reconstructs the lower esophageal sphincter to restore the body’s natural protection against reflux. TIF is often performed in conjunction with upper hiatal hernia repair.

Patients with an uncontrollable chronic cough, bleeding disorder, stricture, esophageal abnormalities or obstructions, esophageal stenosis, or limited neck mobility may not be good candidates for TIF.