GERD Treatment ( Surgical Approach)
Overview of Anti-reflux Surgery
GERD treatment by surgical method aims at creating a new valve which acts a barrier to prevent acid reflux. The most common antireflux surgery that is being performed for the treatment of GERD is known as fundoplication (fundo means top of stomach and plication means to wrap). In this procedure, the upper portion of the stomach is wrapped around the lower end of the food pipe or esophagus and the wrap is stitched in place. This technique increases the antireflux barrier at the junction between the esophagus and the stomach.
In other words, it acts a new valve and prevent back flow of acid into the pipe and restores the body’s natural response.
Aim of Surgery
The aim of surgery is to restore the anatomy of junction between the esophagus and the stomach. This is accomplished by wrapping the upper portion of the stomach (the fundus) around the esophagus either partially or totally. The specific goals of the surgery are:
- Reduction of a hiatus hernia (if present): Normally, the junction between stomach and oesophagus lies in the abdomen below diaphragm.Sometimes the junction between stomach and esophagus gets pulled up into the chest due to the enlarged opening of the diaphragm. This condition is called hiatus hernia. During surgery, the junction is pulled back and the enlarged opening is sutured to prevent recurrence
- Reconstructing the angle at which the esophagus enters the stomach
- To increase pressure of the muscle that controls the valve between the stomach and the esophagus; this recreates a one-way valve to prevent reflux of stomach contents into the esophagus.
How we perform it
Laparoscopic Surgery (Nissen fundoplication)
Though there are a variety of techniques to accomplish the procedure but the most successful and so-called gold standard antireflux surgery has been the laparoscopic Nissen fundoplication. This procedure involves full wrap of the fundus, i.e. 360 degrees around the esophagus and results in an almost normal functioning antireflux valve. This complete wrap is associated with the best results.
The surgery is carried out under general anesthesia i.e. the patient is completely put to sleep before surgery.
Four small 1 cm incisions or holes are created over your abdomen.Telescopic camera and long thin instruments are introduced.
Dissection is carried out and hiatus hernia, if present, is identified and repaired.
Afterwards complete wrap of stomach over lower end of food pipe is carried out.
The holes are closed and the patient is usually discharged within 24-48 hours of surgery.