Gastro esophageal reflux disease, better known as GERD is the reflux of stomach acids back up into the esophagus, which generally produces a sensation of “burning”, commonly known as heartburn up into the esophagus or throat. It is caused by many factors including overeating, being over weight, having a hiatal hernia, and a weak Lower Esophageal Sphincter or LES. Many people whom have GERD have other medical conditions as a result of the reflux, for example, aspiration of stomach contents into the lungs when the patient is lying flat, or increased breathing problems as a result of the aspiration, Barrett’s esophagitis, ulcers of the esophagus, and cancer. There are many ways to control GERD; for example, the use of daily medications, weight loss, eating smaller more frequent meals, changing the types of foods you consume, and surgical correction. Surgical correction is usually the last resort when all other interventions fail and the patients’ symptoms out weigh the risks of surgery.
Many people are not aware that GERD can be surgically corrected with great success. There are a couple of different procedures; but, the most common one is called Nissan Fundoplication. Like most surgical procedures it is named after the physician that first performed it in 1955.
Fundoplication is the re-creation of the LES, this is done by taking the upper portion of the stomach; known as the “Fundus” and wrapping it around the lower end of the esophagus and suturing it in place, this creates the “tightening” affect of the weak LES; furthermore, the hiatal hernia (when a portion of the stomach is coming up through the diaphragm) is corrected as well. The goal of this procedure to correct the defect of the LES and if applicable the hiatal hernia with the result being no more reflux of stomach acids. This surgical procedure has become more popular as the technique has become
more advanced. Back when the procedure was first preformed it required a large incision in the abdominal area requiring a hospital stay of 1 week on average, longer recovery, and greater change for complications from the surgery in whole. Now, the procedure can be performed laparoscopic, thus the recovery is much shorter and the usually hospital stay is 1-2 days when there is no complications. There are complications that can occur with this surgery; as with any surgical procedure, they include excessive bloating, difficulty swallowing because the wrap is too tight, the inability to vomit, risks of infection and bleeding, and the risks of general anesthesia.
The procedure is considered a success when the patient denies reports of reflux and requires no more medication to control the GERD.
BMJ: British Medical Journal
Minimal access surgery compared with medical management for chronic gastro-esophageal reflux disease: UK collaborative randomized trial
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603580/?tool=pmcentrez
A good example of 37 random patients and the benefits of the particular surgical intervention verses that of using commonly prescribed medications for the long term treatment of GERD.
Wikipedia
Nissen Fundoplication
http://en.wikipedia.org/wiki/Nissen_fundoplication
since this particular site is usually my “go to” for quick information on any subject I needed to include it. It gives great information that is easy to understand on the surgical procedure, why it is done, and complications. It also gives a brief view on the history and development of the surgery.
Krames On Demand
Surgery for GERD
http://kramesondemand.com/GERD
A great source for patient education or anyone that is dealing with GERD and would like to know some different options for correction, it is easy to read and doesn’t have a lot of “medical jargon” to understand for the non-medical individual.
WebMD
Heartburn/GERD Health center
Fundoplication surgery for gastroesophageal reflux disease (GERD)
http://www.webmd.com/heartburn-gerd/fundoplication-surgery-for-gastroesophageal-reflux-disease-gerd
this includes the main body of the surgery and how It is preformed with what to expect during the procedure and after the surgery. It also gives information on how well the procedure works and that just because the patient has the surgery they many be required at some point to be placed back on medication. The article states that the more experienced the surgeon the greater success of the surgery. It also goes into detail the tests that have to be performed prior to being “qualified” to have the surgery.
Today’s Surgical Nurse
How do some spell relief? S-u-r-g-e-r-y
Permanent Relief for Heartburn Sufferers
http://www.lapsurgery.com/technque.htm
This is a really neat site; it shows real pictures of the different stages of the surgical procedure and gives great details on what is going on in the pictures. It also explains what the role is of each of the team members. Really interesting site especially if you are one of the few like me that has had this done.
Nissen Fundoplication
http://www.laparoscopy.com/pictures/lap_niss.html
Even better than the previous site with the pictures; however, this site really shows just pictures of the surgery, good ones prior to the fundoplication and the “finished” product. I like these sites, because I am a very “visual” learner.
American Journal of Medicine
The Surgical Option for Gastroesophageal Reflux Disease
http://www.amjmed.com/article/S0002-9343(97)00341-0/
Another informative article on the differences relating to the open procedure and that of the laparoscopic technique, it shows that there was no significant difference with the complications of the open procedure and the laparoscopic procedure and the success rate of the surgery was significantly the same with both.
