Gastroesophageal reflux disease, commonly known as GERD, is a widespread condition presenting with heartburn, regurgitation, throat clearing, cough, hoarseness and pain or difficulty with swallowing food. It is a result of dysfunction of the normal valve mechanism at the junction of the esophagus and stomach. It is often associated with hiatal hernia. When the stomach is displaced into the chest it can cause nausea, vomiting, shortness of breath due to lung compression, pain after eating or progressive inability to swallow food.
This condition is usually treated with antacid medications. For a lot of patients medical treatment brings sufficient relief. It does nor cure the reflux and only makes it non-acid. As a result, some patients continue to have severe symptoms despite the best medical therapy.
For many of those patients, surgical treatment for GERD is an option. Specifically, patients who experience the following may be candidates for surgery. Patients who:
- Do not respond to medications
- Do not want to take medications for the rest of their lives
- Develop side-effects of medications
Have complications of GERD, such as stricture, Barrett’s esophagus or suffer from extraesophageal reflux (caused by irritation by gastric content of the voice box or lungs and presenting with throat burning, hoarseness, chronic cough and asthma-like symptoms.
Both Dr. Turton and Dr. Allen have extensive experience performing Laparoscopic Nissen Fundoplication, the state-of-the-art procedure for treating GERD and repairing Hiatal Hernias. The procedure involves repair of Hiatal Hernia with wrapping part of the stomach around the distal esophagus to re-create a valve mechanism.
Nissen Fundoplication is associated with 5-10% of side-effects like dysphagia (difficulty swallowing), gas-bloat syndrome and inability to burp.The relief of heartburn and regurgitation is excellent.
Among patients suffering from reflux, regurgitation, aspiration of gastric content and difficulty swallowing, there is a group of patients who experience Paraesophageal or giant Hiatal Hernia (intrathoracic stomach when more than 30% of stomach herniates into the chest). Symptomatic patients are also treated with Laparoscopic Fundoplication with Hiatal Hernia repair. The presence of large hiatal hernia is associated with more severe symptoms and can cause the stomach or other organs to become srangulated within the hernia. This group of patients has only one reliable treatment option – Laparoscopic Hiatal Hernia, often with the need for mesh to reinforce the weak area.
A related procedure is utilized for a condition called Achalasia. This disease present with similar symptoms and is caused by inability of esophagus to contract and push food down into the stomach. At the junction with the stomach esophageal muscles looses ability to relax for food bolus passage creating a stricture-like narrowing. The only long-term effective treatment for this condition is Heller’s myotomy (incision of the scarred, non-relaxing muscle). This procedure is also combined with partial fundoplication for better functional results.
It is known that in obese patients results of anti-reflux surgery is not as successful as it is with lighter patients and therefore it is associated with higher rate of recurrence with increasing BMI (you can calculate you BMI by clicking on page above). In this situation bariatric surgery, primarily Gastric Bypass has been shown to resolve symptoms with adequate weight loss in 90-95% of patients.For Obese patients with GERD, Laparoscopic Gastric Bypass frequently gets rid of the unhealthy weight as well as resolving the GERD, a win-win outcome.