Gastroesophageal Reflux Disease (GERD) - Surgery

Surgery

Fundoplication surgery may be used to treat gastroesophageal reflux disease (GERD) symptoms that have not been well-controlled by medications. In fundoplication surgery, the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place to strengthen the valve between the esophagus and stomach (lower esophageal sphincter).

Surgery may be an option when:^{5, 6}

• Treatment with medications does not completely relieve a person's symptoms, and the remaining symptoms are proved to be caused by reflux of stomach juices.
• A person does not want or, because of side effects, a person is unable to take medications over an extended period of time to control his or her GERD symptoms and is willing to accept the risks of surgery.
• A person has symptoms such as asthma, hoarseness, or cough along with reflux that do not adequately improve when treated with medications.

Surgery to treat gastroesophageal reflux disease (GERD) is rarely done on people who:¹

• Are older adults, especially if they have other health problems in addition to GERD.
• Have weak squeezing motions (peristalsis) in the esophagus. These motions are important to move food down the esophagus to the stomach. Surgery may make this problem worse, causing food to get stuck in the esophagus.
• Have other symptoms that might be made worse by surgery.

Surgery Choices

Fundoplication surgery is the most common surgery used to treat GERD. This surgery strengthens the valve between the esophagus and stomach (lower esophageal sphincter) to keep acid from backing up into the esophagus as easily.

Other types of surgery for gastroesophageal reflux disease may include:

• Partial fundoplication. Partial fundoplication (Toupet procedure) involves wrapping the stomach only partway around the esophagus. Full fundoplication involves wrapping the stomach around the esophagus so that it completely encircles it. Most fundoplication surgery uses the full fundoplication method.
• Gastropexy. A gastropexy attaches the stomach to the diaphragm so that the stomach cannot move through the opening in the diaphragm into the chest. Gastropexy is done less often than fundoplication.

Some relatively new nonsurgical procedures used to treat GERD are still undergoing trials to determine their long-term safety and effectiveness. These include:

• Stretta radiofrequency procedure. The Stretta procedure uses radiofrequency energy delivered through an endoscope to tighten the lower esophageal sphincter. The Stretta procedure is relatively new, and more research is needed on possible complications.
• EndoCinch procedure. An endoscopic sewing device is used to make a series of sutures that will adjust the lower esophageal sphincter so that it blocks acid reflux more effectively. Early trials have shown that complications from the procedure may be problematic, and further trials are needed to determine its effectiveness.⁷

What To Think About

When done by a highly experienced surgeon, fundoplication surgery is successful in 50% to 90% of cases.⁶ Successful surgery relieves GERD symptoms and inflammation of the esophagus (esophagitis). However, there is little information on whether fundoplication surgery is stable and effective over the long term, and many people continue to take some medications after surgery.⁶

Fundoplication surgery using a laparoscopic technique is being done more often. In this method, a thin, lighted tube (laparoscope) is inserted into the abdominal cavity through a very small incision in the wall of the abdomen. The laparoscope allows the surgeon to see inside the abdomen without making a large incision. Surgical instruments can also be inserted through additional small incisions. Recovery time and hospital stays are both shorter with laparoscopic surgery than with open surgery, which requires a larger incision. When choosing a surgeon, experience is the most important consideration. Find out the number of these procedures the surgeon has performed and their success rate.

Should I use medications or surgery to treat gastroesophageal reflux disease (GERD)?

Before surgery, additional tests will usually be done to be certain surgery is likely to help relieve the person's GERD symptoms and to diagnose problems that surgery could make worse. For more information on this testing, see esophageal testing in the Exams and Tests section of this topic.