Gastroesophageal reflux surgery, also known as antireflux surgery, is a treatment for gastroesophageal reflux disease, or GERD.
In this condition, gastric acids “recede” or flow back from the stomach into the esophagus, causing as the main symptom a strong burning or heartburn sensation in the area between the ribs or just below the neck, this sensation being able to radiate through the chest and to the throat. It can also cause other symptoms, including vomiting or regurgitation, difficulty swallowing, chest pain, and chronic cough or wheezing.
Causes of gastroesophageal reflux
In the lower area of the esophagus, where it joins the stomach, there is a muscular ring that is called the lower esophageal sphincter and works as a one-way valve, allowing food to pass into the stomach and closing immediately after swallowing to prevent gastric acids from backing up into the esophagus.
When the lower esophageal sphincter does not work as it should, either because these muscles are weakened (in some cases, some people are already born with a weak lower esophageal sphincter), do not close well or are disturbed, this allows stomach acids to back up into the esophagus burning its lower portion. As a consequence, it becomes irritated and inflamed, causing the symptoms of heartburn and burning reflux, and it may even occur over time that these acids end up causing damage to the esophagus.
Another possible cause of reflux is that the patient has a hiatal hernia, which occurs when the stomach is displaced up into the chest through the esophageal hiatus of the diaphragm, disrupting the antireflux mechanism of the junction between the stomach and the esophagus causing reflux or worsening of it.
Finally, other factors can also cause the lower esophageal sphincter to relax, causing reflux to occur: eating fatty and spicy foods, certain types of medication, wearing very tight clothing, smoking, alcoholism, intense exercise or changes in the body position (crouch or lie down).
Treatments for gastroesophageal reflux disease
For the treatment of gastroesophageal reflux, in the first place it is tried that the patient makes changes in his style and habits of life:
- Lose weight, if the patient suffers from obesity.
- Stop smoking and avoid alcohol consumption.
- Changes in diet, avoiding foods rich in fat, spicy or acid, as well as coffee. Take preferably skimmed foods, lean meats (such as chicken, turkey or blue fish), without forgetting vegetables, which do not usually cause reflux symptoms.
- When sleeping, especially in those cases in which you suffer from nocturnal symptoms, raise the head of the bed.
In many cases, these changes in habits reduce the frequency and severity of reflux. If this is not enough to achieve improvement and the symptoms of reflux persist, then pharmacological treatment is used, which consists of antacid medications that neutralize gastric acids and reduce the amount of these that are produced, alleviating the symptoms. The specialist will indicate the most appropriate treatment for each patient.
Finally, in those cases in which neither changes in lifestyle nor medication have been effective in reducing the symptoms of reflux, or in which the patient requires medication continuously to control the symptoms, the possibility remains of resort to surgical treatment.
Gastroesophageal reflux surgery: what it consists of and types
In those cases in which it is considered necessary to resort to surgery, in the first place, various tests are performed on the patient (blood tests, esophageal manometry, pH measurement, gastroscopy), which are useful both to confirm the diagnosis and to predict the degree of success of the surgery.
In anti-reflux surgery, known as Nissen fundoplication, first and in the case that the patient has a hiatal hernia, the surgeon repairs it, putting the stomach back in place in the abdomen and reinforcing the opening in the diaphragm by means of sutures in order to prevent the stomach from being able to move upwards through this opening. After the hiatal hernia is repaired (or if there was none), the surgeon wraps the upper part of the stomach around the end of the esophagus with sutures, which apply pressure, thus strengthening the lower esophageal sphincter, helping to prevent gastric acid and food back up into the esophagus.
This surgery can be performed using different techniques, selecting the most appropriate surgeon for each case:
- Laparoscopic technique: this minimally invasive technique is the most frequently used procedure for gastroesophageal reflux surgery. To carry it out, the surgeon makes 3 to 5 small incisions in the abdomen, so that through one of them the laparoscope is inserted (an instrument shaped like a thin tube with a small camera at its end, allowing the surgeon to view the inside of the abdomen on the monitor) and through the others the necessary surgical instruments and tools. As the incisions are made as small as possible, the scars from the surgery are smaller and the recovery is faster with less discomfort.
- Open surgery: in very few cases, due to factors such as obesity or previous abdominal surgery that left dense scar tissue, or if bleeding problems occur during surgery, it may not be possible to perform the surgery laparoscopically, the surgeon deciding that the safest option for the patient is to perform the surgery openly. In these cases, a single large incision is made in the abdomen, through which the surgery is performed.
- Endoluminal fundoplication: this is the most recent technique, in which it is not necessary to make any incision, since the procedure is carried out by introducing a flexible tool with a camera (endoscope) through the mouth to where the esophagus meets the stomach, where the surgeon will use this tool to place small staples that will help prevent food or stomach acid from backing up.
Regardless of the technique used, the surgery lasts approximately 2 to 3 hours and is performed under general anesthesia, with the patient asleep and painlessly.
Gastroesophageal reflux surgery at Vithas Xanit Internacional
If you are looking for a specialist for the treatment or surgery of gastroesophageal reflux, at Vithas Xanit Internacional you will find the best, who together with our cutting-edge medical technology and the most recent treatment and surgical techniques allow us to offer our patients the best care and the best possible results. Contact us for more information or make an appointment.