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Does Having Surgery Improve Acid Reflux Symptoms?

Depending on how severe your acid reflux symptoms or gastroesophageal reflux disease (GERD) condition is, you may require surgery in order to improve your symptoms, health, and overall lifestyle. Surgery is an option when lifestyle changes and medicine do not help you manage your acid reflux/GERD symptoms. For some, surgery can provide them a reasonable alternative to a lifetime of discomfort and medications.

However, you may be wondering what types of surgeries are available and just how effective they are. The following is a brief overview of the most common surgeries associated with GERD and their general success rate.

Fundoplication Surgery

Nissen Fundopication Surgery is the standard surgical treatment for GERD and was developed over 50 years ago. This procedure is designed to prevent or reduce acid reflux from occurring so that esophagitis (inflammation of the esophagus) can heal.

Fundoplication involves gathering and wrapping the fundus (upper curve of the stomach) around the lower area of the esophagus, and stitching the wrap in place. This enables the lower part of the esophagus to pass through a small channel that has been created out of the wrapped stomach muscle. The objective of the surgical procedure is to strengthen the lower esophageal sphincter (LES) to prevent stomach acid from entering into the esophagus. It is also important to mention that during this procedure if a hiatal hernia is present within the patient, this is also treated. A hiatal hernia is when part of the stomach protrudes through the diaphragm. The condition is believed to weaken the LES.

Fundoplication can be performed in two ways:

1. Laparoscopic fundoplicaiton - this is the most common and less invasive procedure. The surgeon makes a small cut in the abdomen and inserts a laparoscope (thin lighted tube with a videocamera) in the incision. Four additional pinpoint incisions are then made in the upper abdomen, and needle-like instruments are inserted to allow the surgeon to perform the procedure.

2. Open fundoplicaiton - In this procedure, the surgeon makes wide surgical incisions in the abdomen or chest, performs the surgery, and sews up the patient. Open fundoplication is typically only used for obese patients, or if complications occur with the laparoscopic procedure.

How successful is fundoplication surgery? Studies have found that many people who undergo the procedure experience improvement in their symptoms. In more than 50% of cases, patients experienced successful relief from GERD symptoms and esophagitis. However, many of these same patients still required GERD medications to treat remaining symptoms. That being said, medications are often reduced and do not to need to be taken on as regular a basis and most symptoms tend to be less severe than before the surgery.

Studies have found that approximately between 10 and 20% of patients who underwent surgery continued to have regular symptoms, and others who experienced complications from the surgery, required a second surgery within a decade of having the first.

You should be aware that the fundoplication surgery is irreversible and the long term effect of fundoplication for an individual is unknown.

Stretta Procedure

Stretta procedure is designed to reduce the occurrence and severity of heartburn and other acid reflux symptoms by tightening and strengthening the LES.

This procedure is performed with an endoscope and a Stretta device. An edoscope is a small illuminated flexible tube that features different channels where medical instruments can be inserted. A Stretta device is a very thin catheter that has a balloon at the end.

The patient swallows the endoscope and it moves down the esophagus to rest just above the stomach. The Stretta device is then inserted and the balloon is inflated. The outside of the balloon features four sharp probes that are designed to discharge controlled levels of radio frequency energy into the LES and the uppermost region of the stomach known as the gastric cardia. The electrodes make thermal lesions on the selected areas. After these lesions heal, the LES muscle toughens.

How successful is Stretta procedure? Many studies have found that up to 80% of patients who underwent the surgery experienced an improvement in their acid reflux symptoms. Many of the patients had a decrease in heartburn and other acid reflux symptoms within one month of undergoing the Stretta procedure. These patients managed to stop taking GERD medications with only encountering little or no discomfort.

The vast majority of patients stop taking their medications between 1 and 2 months after the surgery, but it is not uncommon for patients not to experience improvement of symptoms until 6 months after the procedure. Furthermore, a number of patients found that a year after their procedure their symptoms were further improved or ceased altogether.

The long term effect of Stretta procedure is unknown.

EndoCinch

The Bard EndoCinch Suturing System, commonly known as EndoCinch, is a procedure designed to help prevent and reduce the occurrence of acid reflux symptoms and heartburn, as well as reduce the need for GERD medications. This is achieved by altering the gateway between the esophagus and the stomach by placing pleats in the LES.

EndoCinch is performed using an endoscope and the Bard EndoCinch Suturing System. The patient swallows the endoscope which rests just above the stomach, and the EndoCinch is inserted. The medical physician than uses the EndoCinch to make a series of two adjacent stitches below the LES, and then pulls the stitches together to create a pleat. Although most patients typically only require one pleat, others may require additional pleats depending on their condition.

How successful is EndoCinch? Clinical trials have found that approximately 70% of patients experienced an improvement in overall symptoms, and 75% reduced their intake of GERD medications.

The long term effect of EndoCinch is unknown.

Regardless of the GERD surgery, you need to keep in mind that everyone responds differently to treatment and individual results may vary. Therefore, while some people may no longer need to take medications or restrict their diet, others may be required to continue with medications and lifestyle changes to prevent and relieve acid reflux symptoms.

Before you consider surgery, you need to understand every surgical procedure has some risk, and not everyone who undergoes surgery will obtain successful results in relieving their acid reflux symptoms. Therefore, make sure you know everything about the surgery including what is expected of you, and all possible outcomes. You need to ask your doctor any questions you may have, and after weighing all the risks, carefully determine if surgery is the right option for you.

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