“Some gastroesophageal reflux disease (GERD) procedures are performed as open surgeries through surgeons’ incisions in the abdomen,” says Dr. Samrat Jankar, among the leading gastrointestinal surgeons from Pune.
Laparoscopic surgeries, which require small incisions, are another option. Surgeons may also use Non-surgical options that are performed as outpatient procedures.
Medication and lifestyle changes, such as a change in diet, are usually the first steps in treating GERD. However, if these do not work, surgery may be an option.
The pros and cons of GERD surgery and recovery times, complications, and success rates are discussed in this article. It also looks into other options for treating GERD.
What is GERD?
GERD is an acronym for gastroesophageal reflux disease.
Stomach acid enters the esophagus, which connects the mouth and stomach when a person has GERD.
This is referred to as acid reflux by doctors. It can irritate and damage the esophageal lining.
According to Dr. Samrat Jankar, many people occasionally experience acid reflux or gastroesophageal reflux (GER), especially after consuming spicy foods or consuming a large, heavy meal.
On the other hand, GERD is a chronic condition that causes symptoms at least twice a week.
Heartburn, a burning sensation in the chest, is one of the symptoms of GERD.
Symptoms of GERD include:
- a painful feeling in the chest called heartburn
- chest discomfort
- difficulties with swallowing
- nausea
- regurgitation of food or stomach acid
- feeling like there is a lump in the throat
Types of GERD surgeries and other medical procedures
If a person with GERD does not get relief from medications and has complications from the condition, such as bleeding or ulcers, doctors may recommend surgery or other medical procedures.
Surgeons can use a variety of procedures to help a person with GERD symptoms. They are as follows:
Fundoplication
The gold standard in GERD surgery is fundoplication. The surgeon uses the upper part of the stomach during the procedure to reinforce and tighten the lower esophagus and strengthen the sphincter. This muscle bundle keeps the stomach contents from moving back up the esophagus.
According to Dr. Samrat Jankar, Fundoplication can be done laparoscopically (keyhole surgery) or openly (open surgery).
Open surgery is more invasive, and the surgical wound is more significant, resulting in a longer recovery time.
Linx surgery
The Linx is a tiny ring made up of magnetic titanium beads. The surgeon wraps the Linx around the lower esophageal sphincter during the process to compress and strengthen the area.
Because of their magnetic nature, the Linx can open and close to allow food to pass through while preventing stomach acid from entering the esophagus.
The procedure is simple, safe, and practical, with a quick recovery time.
Transoral incisionless fundoplicationÂ
TIF is a non-surgical treatment of GERD symptoms by healing the original reflux barrier. Doctors may choose the TIF procedure if fundoplication is not a choice for someone.
During TIF, a surgeon uses the EsophyX device, which is a one-of-a-kind tool. The device is inserted into the mouth and then down the esophagus.
The device folds the skin at the bottom of the esophagus to create a new stomach valve that prevents acid reflux.
Although anesthesia is required, the recovery time is minimal due to the lack of incisions.
Procedure of Stretta
An endoscope and radiofrequency energy are used in the Stretta procedure. Because Stretta is non-surgical, minimally invasive, and has a quick recovery time, surgeons frequently perform it outpatient.
An endoscope is inserted down the esophagus during the Stretta procedure. The radiofrequency waves are delivered through this tube to the junction of the esophagus and the stomach.
The radio waves cut the esophageal tissue into tiny slices. As these cuts heal, scar tissue forms, strengthening the area and blocking the nerves that react to acid reflux.
Water is also delivered through the endoscope to prevent heat damage to other parts of the body.
Stretta appears to be in good hands. Only 29 adverse events or problems were reported in over 15,000 Stretta procedures, according to a 2013 review.
Stretta procedures reduced exposure to stomach acid within the throat, decreased the requirement for proton pump inhibitor medications, and significantly improved patients’ quality of life, according to a 2017 systematic review involving 2,468 patients.
Recovery time
The amount of time it takes to recover depends on the type of surgery and the individual. More invasive procedures necessitate a longer recovery period.
After GERD surgery, most people stay in the hospital for 1–3 days. The inpatient stay allows doctors to keep a close eye on the patient.
If a person can eat, drink, and swallow without difficulty and is not experiencing any side effects, they can be discharged from the hospital.
Following GERD surgery, patients are usually restricted to a soft, puréed food or liquid diet.
These dietary restrictions differ from person to person, but most patients gradually return to a solid diet over 2–8 weeks.
Additionally, surgeons may advise patients only to take crushed or liquid medications after surgery and for a few weeks while they recover.
Doctors can perform Linx and other minimally invasive procedures as outpatient procedures or with a one-day stay.
Rates of success
The success rate of laparoscopic GERD surgery is usually very high. Most people say they are pleased with the surgery, their symptoms have decreased, and their quality of life has improved in short-term and long-term studies of up to 10 years.
Following GERD surgery, the majority of people no longer require reflux medication.
Complications and risks
As with any surgery, there are risks and complications of GERD surgery, including:
- the esophagus moving so that the stomach no longer holds the valveÂ
- difficulties swallowing if the stomach wraps around the esophagus extremely tightly
- heartburn that returns
- discomfort, bloating, or excess gas
Because the esophageal-gastric junction is so complicated, the surgical correction can weaken over time—up to thirty percent of individuals who have the fundoplication method encounter structural complexities.
Other options for treatment
Any surgery is a significant step. Surgery is often the last resort, and people should try lifestyle changes and medications first to alleviate their GERD symptoms.
These may include:
- altering diet, including orange juice, avoiding alcohol, or tomatoes
- keeping the head elevated while sleeping
- quitting smoking
- keeping a moderate weight
- taking over-the-counter GERD medicines, like antacids
If these measures don’t help, a doctor may prescribe prescription-strength H2 blockers or proton pump inhibitors (PPIs).
People can purchase over-the-counter versions of these medications, though they may not provide the same results as prescription-strength medications.
H2 blockers and proton pump inhibitors (PPIs) reduce the amount of acid produced by the stomach, allowing the esophagus to heal.
PPIs are more effective and, in most cases, can heal the esophageal lining.
These drugs are generally safe, but some people may experience side effects such as headaches, diarrhea, and digestive problems.
What are some good questions to ask a doctor?
A person must determine whether surgery is the best option for them.
Here are some questions to consider in order to understand your treatment options better:
- What are your recommendations for medical treatment?
- What are the surgical treatment options you suggest?
- Will my GERD get worse if I don’t have surgery?
- What are the surgery’s side effects and risks?
- Do you think I’d be a good candidate for laparoscopic surgery?
- How effective are these antireflux procedures?
- Will I ever require additional surgery?
- What will the post-recovery process entail?
Summary
GERD is a digestive disorder in which stomach acid rises into the esophagus, resulting in heartburn and other symptoms. GERD, if left untreated, can lead to severe complications, such as esophageal cancer.
Individuals who are unable to control their GERD with medication and lifestyle changes may consider GERD surgery.
Fundoplication, TIF, Stretta, and Linx are some of the options available.
In the case of Stretta, surgeons can perform these procedures as open or laparoscopic surgeries or non-surgically.
Surgery has a high success rate, and most people no longer need medications to control their GERD.
