Surgical Options for GERD (Gastroesphageal Reflux Disease)
Whilst surgery would not be a consideration for someone suffering the odd bout of heartburn every now and again, many long standing sufferers of GERD do take this route. As with any surgical procedure, arriving at the decision to have surgery performed is not one that should not be undertaken lightly and, it will only normally be considered by your doctor if all other treatment options are unsuccessful or unsuitable.
The surgery is undertaken to help strengthen the functioning of the lower esophageal sphincter ( LES) through which the stomach acid escapes or refluxes back into the esophagus. The most popular procedure to strengthen the LES is called a Nissen Fundoplication. It is named after Dr. Rudolph Nissen who performed his first fundoplication in 1955, but his procedure did not gain widespread use until the 1970s. During fundoplication surgery, the upper part of the stomach, which is called the fundus, is wrapped around the esophagus like a collar and sewn into place so that the lower portion of the esophagus passes through a small tunnel of stomach muscle. When Nissen carried out his first operation he would have used traditional open surgery and this would have been the case until the developments in laparoscopic or key hole surgery techniques. This made it possible to carry out the procedure via just three or four small incisions in the abdomen. Laparoscopy is now the most popular method for carrying out a fundoplication. This method of surgery has continued to advance and some surgeons now carry out the whole procedure through just one small incision to the navel or belly button. This has the advantage of there being fewer incisions to heal and from a cosmetic point of view means that there is no visible scarring from the operation. In the last couple of years there has been another method of carrying out a fundoplication which uses no incisions at all. The whole process is carried out via the esophagus and is called a transoral incisionless fundoplication (TIF) using EsophyX ™.
There are other endoscopic techniques that are used to treat GERD, the Bard EndoCinch, the NDO Plicator and Stretta system. The EndoCinch and Plicator systems are fairly similar and use a patented endoscopic device to put stitches around the LES to strengthen the muscle. The Stretta system uses radio frequency energy delivered via needle electrodes to heat the surface of the esophagus to create six rings of thermal lesions. These lesions damage nerve pathways helping to reduce inappropriate relaxation of the LES and once healed produce scar tissue which strengthens the sphincter.