Minimally invasive surgical treatments may help patients who have gastroesophageal reflux disease (GERD).
Common Symptoms: Heartburn, Regurgitation, Dysphagia
Approximately 10 to 20 percent of people in the United States have the most common symptoms of gastroesophageal reflux disease (GERD): heartburn, regurgitation, and dysphagia. (Less common symptoms include bronchospasm, laryngitis, chronic cough, or chest pain.)
Symptoms are considered clinically significant if they occur in a mild form two or more days per week, or in a moderate to severe form more than one day per week.
After ruling out conditions such as esophagitis or Barrett’s esophagus, a presumptive diagnosis of GERD can be made based on clinical presentation alone.
Medical Management, and When to Consider Surgery
For patients with mild GERD, symptoms may improve by losing weight, changing diet, and/or taking antacids, H2 blockers, or proton pump inhibitors.
However, surgical treatment may be recommended when:
Medication doesn’t completely relieve symptoms that are known to be caused by reflux;
A patient cannot take medication long-term due to side effects; or
In addition to reflux, a patient has asthma, hoarseness, or cough that does not improve with medication.
It may also be an option for those who do not wish to stay on medications permanently in order to control their symptoms
Minimally Invasive Endoscopic and Surgical Options
The type of therapy chosen is tailored to individual patient characteristics such as age, presence of a hiatal hernia, how well the esophagus works and others. The minimally invasive endoscopic and surgical treatment options for patients with well-established GERD are:
Laparoscopic Anti-reflux Surgery (LAR). This is the most common surgical treatment for GERD. The surgeon creates a new antireflux valve around the lower esophageal sphincter using the fundus of the stomach. Different types of fundoplication are available such as the Nissen, Toupet or Dor fundoplications. LAR allows food and drink to enter the stomach, but prevents stomach contents from flowing back up into the esophagus. LAR surgery requires five to six small incisions (5-12 millimeters) in the abdomen.
LINX® Reflux Management System. The LINX® system is a small ring of interlinked titanium beads with magnetic cores that surgeons implant laparoscopically. After implantation, the beads bolster the existing structure of the lower esophageal sphincter and prevent reflux. During swallowing, the beads relax, so food passes through the esophagus to the stomach and also allow patients to belch or vomit if necessary.
Transoral Incisionless Fundoplication (TIF). This incisionless procedure involves introducing a device (EsophyX) through the mouth to create a partial antireflux valve. The surgeon positions the device at the gastroesophageal junction, where it partially wraps the stomach around the esophagus to create a fold which functions as the partial antireflux valve.
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