Anti-reflux Surgery

The esophagus is a muscular passage which carries food from the mouth to the stomach. The lower esophageal sphincter (LES) is a circular band of muscles at the lower end of the esophagus that acts a barrier between esophagus and the stomach.

Gastro-esophageal reflux disease (GERD) is a chronic disease that occurs when the lower esophageal sphincter closes incompletely allowing the stomach contents to leak back or reflux into the esophagus. In certain individuals, a hiatal hernia may be present which can also be a cause of reflux or heartburn. In some individuals, this causes heartburn, a burning sensation felt in the chest or throat when the refluxed stomach acid touches the lining of the esophagus. Additionally, some have significant regurgitation of acid, bile, or food contents which can be debilitating.

We are proud to offer the full range of interventions for reflux. Interventions include Stretta, LINX, Laparoscopic or Robotic Nissen Fundoplication, and in individuals with a BMI above 35kg/m2, Laparoscopic or Robotic Gastric Bypass.

Stretta is a completely endoscopic (no incision) procedure that works over time to restore the anti-reflux barriers in the lower part of the esophagus. Nissen fundoplication and LINX are both minimally invasive procedures performed to restore the function of lower esophageal sphincter. Gastric bypass helps to isolate the acid producing portion of the stomach from the esophagus, thereby eliminating reflux.

Indications

  • GERD
  • Hiatal hernia is a condition in which the stomach bulges up into the chest through an opening in the diaphragm.
  • Chronic esophagitis (inflammation of esophagus)
  • Barrett's Esophagus
  • Failed conservative treatment measures such as medications and lifestyle modification.
  • Lack of desire to stay on acid reducing medications indefinitely

Surgical Procedures

Stretta

  • Stretta

    Stretta

    is a minimally invasive nonsurgical procedure usually recommended for the treatment of gastroesophageal reflux disease (GERD). The procedure is advised if a patient has not responded favorably or is not a good candidate for medical or surgical therapy. The Stretta procedure helps to strengthen the muscles that connect the throat to the stomach to reduce acid reflux.

    For the procedure, you will be sedated with anesthesia after which your doctor will insert a special tube down your throat. This tube delivers mild radio waves to the junction between the esophagus and the stomach. Water is also delivered through the tube to prevent any thermal injury. The entire procedure should be completed in about an hour. You will usually be advised to rest for the reminder of the day following the surgery and be able to return to work the next day.

    GERD patients can expect reduction in their symptoms following the Stretta procedure for up to 10 years. The procedure is considered safe and can be repeated if the symptoms return. Rarely, complications can occur and include anesthesia risks, throat irritation or injury, food left in stomach too long and gas or bloating.

LINX

  • LINX

    LINX

    , is a new and innovative magnetic bracelet-like device that wraps around the bottom portion of the esophagus. This is placed through laparoscopic or robotic techniques. When you swallow, the magnets relax allowing for passage of food. However, these magnets are increasing the effectiveness of the lower esophageal sphincter to help prevent reflux or heartburn. This functions as a two-way valve allowing for reliable passage of food but limiting problematic reflux symptoms.

Nissen Fundoplication

  • Nissen Fundoplication

    Nissen Fundoplication

    long-held as the gold standard in surgical treatment of reflux, the surgeon wraps the top most portion of stomach around the esophagus to prevent the back up of acid from the stomach into the esophagus. This functions as a one-way valve limiting reflux symptoms. The procedure is typically performed laparoscopically or robotically.

     

Gastric Bypass

  • Gastric bypass

    For

    Gastric bypass

    please see “Weight Loss Surgery”

    The acid producing portion of the stomach is isolated from the esophagus, thereby limiting the possibility of acid and/or bile from traveling from the stomach into the esophagus to cause reflux or heartburn symptoms. In patients with a BMI > 35kg/m2, this is usually the most favorable option as it addresses multiple contributors to reflux disease. This is also performed through minimally invasive techniques.

After the surgery

Following the surgery, your surgeon may recommend you follow certain measures for a successful outcome:

  • Avoid heavy lifting and activities that put excessive pressure on the abdomen.
  • Your doctor will prescribe medications to relieve pain.
  • Keep the incision area clean and dry.
  • Your post-operative diet will be dictated by the type of procedure performed.