People with gastroesophageal reflux disease, or GERD, are all too familiar with limited menu choices at restaurants. They know they need to steer clear of tomato-based, spicy, fatty or fried foods, chocolate, citrus fruits, and alcoholic or caffeinated drinks if they want to avoid heartburn and other uncomfortable symptoms.
"GERD develops when the lower esophageal sphincter (LES), a muscle located at the low end of the esophagus where it meets the stomach, does not close properly. Stomach contents and acid can then back up, or reflux, from the stomach into the esophagus," said Dr. Matt Ricks, general surgeon on staff at Des Peres Hospital. "GERD is typically diagnosed when symptoms of heartburn or acid indigestion occur twice a week or more. If left untreated, GERD may cause esophageal bleeding or ulcers, narrowing of the esophagus that can cause swallowing problems, a precancerous condition called Barrett’s esophagus, or difficulties breathing."
Lifestyle changes such as a modified diet, weight loss, smoking cessation, or altered sleep patterns, as well as drug therapy, can help treat GERD. But when symptoms do not improve and medications are no longer effective, surgery may be recommended to control the condition.
Dr. Ricks said there are several surgical methods to treat symptoms of GERD, including an open procedure and a laparoscopic surgery called Nissen fundoplication. These surgeries involve wrapping the upper part of the stomach around the LES and attaching it there. This creates a tighter band designed to keep food and acid from coming back up. The laparoscopic surgery uses an instrument connected to a tiny video camera that is inserted through a small incision. This type of surgery, which requires making three to five small cuts in the abdomen, allows the surgeon to see a magnified view of the patient’s intra-abdominal organs and perform the entire operation internally using instruments inserted through the other cuts.
"A new surgical method, transoral esophagogastric fundoplication, takes the techniques of Nissen fundoplication surgery and uses the openings of the mouth and esophagus to provide entry for the surgical instruments," said Ricks.
He explained that once the patient is properly sedated and has breathing support in place, a very flexible endoscope is inserted into the stomach through the mouth and down through the esophagus to provide the surgeon with a view of the patient’s LES. The surgical instruments use the same route and allow the surgeon to fasten the upper part of the stomach around the LES.
"With this type of surgery, patients do not have any abdominal wall incisions," said Ricks. "Most patients only stay in the hospital for the first day after surgery to ensure adequate pain control and to check for any problems."
He noted that patients preparing for laparoscopic fundoplication may be asked to stop taking aspirin, ibuprofen, vitamin E, warfarin (blood thinners) and other drugs that could affect blood clotting several days to a week prior to surgery. Some herbal and over-the-counter medications also may interfere with clotting so discuss all medicines you take with your physician. The day of surgery, patients should not eat or drink anything after midnight the night before. Patients may need to alter their diet after surgery and continue with their GERD medications for a few weeks. If you are considering this type of surgery, you should ask your surgeon about when you can resume normal activities.
Fundoplication is considered safe, but as with any operation there could be complications. "Most patients become symptom-free after the procedure or have a significant improvement in GERD side effects," said Ricks.