Gastroesophageal Reflux Disease, also known as GERD, impacts approximately 30 to 40% of American adults. Normally, upon swallowing, a valve between the esophagus and stomach opens up allowing food to pass and then closes to prevent stomach contents from “refluxing” back into the esophagus. For people who suffer from GERD, there is a dysfunction in the valve as it is unable to prevent acid from refluxing into the esophagus thus resulting in a burning sensation in the chest.
GERD can be disruptive, painful and potentially dangerous if severe heartburn has caused Barrett’s esophagus which increases cancer risks. Initial treatment options include stomach medications, weight loss, elevation of the head of bed, and diet alterations. Surgery is the next option for people who do not want to stay on medicine long term or have not found relief from medications/non-operative management. Before deciding upon surgery, your physician will most likely perform a number of diagnostic tests to ensure the right treatment option.
Surgical management can eliminate the need for the long-term use of medication to control symptoms of GERD. Severe GERD is commonly treated with laparoscopic Nissen Fundoplication. Dr. Rudolf Nissen performed the first fundoplication in the 1950s for treatment of severe reflux esophagitis. The original procedure has been modified multiple times since then; however, laparoscopic Nissen fundoplication is now a standard surgical approach to treat GERD.
“This procedure is performed, in essence, to recreate and strengthen the natural valve between the stomach and esophagus” says Premier Surgical surgeon David J. Harrell MD FACS. To complete the procedure the upper stomach is wrapped around the esophagus to create a one way nipple valve. With this valve functional the acid is much less likely to have the opportunity to travel back up into the esophagus.
Nissen Fundoplication can usually be performed laparoscopically or robotically through the abdomen in a minimally invasive manner. These techniques involve small keyhole incisions in the abdomen through which tiny camera and instruments are inserted allowing the surgeon to perform the procedure. As with most abdominal surgeries, carbon dioxide is used to inflate the abdomen to allow for better viewing and more room for the surgeon to perform the actual procedure.
Following the procedure, patients are prescribed a liquid or soft diet for several weeks to allow the esophagus to heal and swallowing function to recover. Most patients are able to return to work and normal activity within 2 to 4 weeks.
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