The best way to treat reflux symptoms is to block acid production in the stomach. In many cases, acid irritation causes the symptoms. Acid can usually be blocked by using several medications. More than half of all patients get better with acid-suppression therapy. Most physicians will treat a patient who has reflux with acid suppression for about two months before pursuing other treatment.
Surgery for acid reflux is considered when:
- Symptoms do not improve with medications
- Lifelong medication is needed
- The patient is unwilling or unable to take medication regularly
- There is severe damage to the esophagus
The goal of surgery is to repair the stomach valve that allows acid to seep into the esophagus. Certain tests are performed prior to surgery to ensure that the patient’s condition is likely to be helped by surgery.
Patients are generally evaluated using endoscopy, 24-hour pH studies, manometry or barium X-rays.
In many cases, the operation that is performed to correct gastroesophageal reflux is a procedure called fundoplication. Usually the upper portion of the stomach (the fundus) is wrapped (plicated) around the lower portion of the esophagus and is anchored below the diaphragm.
As a result:
- The physical barrier that allows for the passage of material in or out of the stomach is strengthened.
- A new flap valve is created at the entrance of the stomach.
- The wrap “inflates” as the stomach is filled; therefore, a full stomach has a tighter valve than an empty one.
- All of the factors that would normally create valve pressure (esophageal muscle, the diaphragm and abdominal pressure) are superimposed on each other for maximum effect.
The operation can be effective long term in stopping esophageal reflux and relieving symptoms.
More than 90 percent of patients who have fundoplication surgery are able to leave hospital the next day, eating a soft diet. Most people are able to return to their normal activities, work or school within one to two weeks after surgery. The satisfaction rate with this procedure is 96 percent at one year.
Fundoplication has recently undergone several improvements. Using a laparoscope and several very small incisions, the surgeon can operate without making a large incision to open the abdomen. The result of the operation is the same, but the patient is spared the long hospital stay and prolonged recovery time of open surgery. There is also less pain after the surgery and less chance of wound infection as well as smaller scars do to the smaller incisions.
Five small abdominal incisions are used for laparoscopic fundoplication. Each incision is .5 to 1 centimeter long.