Laparoscopic Surgery for Gastroesophageal Reflux Disease (GERD)

How does gastroesophageal reflux disease (GERD) develop?

At the lower end of the esophagus, where it joins the stomach, there is a circular ring of muscle called the lower esophageal sphincter (LES). After swallowing, the LES relaxes to allow food to enter the stomach and then contracts to prevent the back-up of food and acid into the esophagus.

However, if the LES is weak or becomes relaxed, it allows liquids in the stomach to wash back into the esophagus, which damages the esophageal mucosa.

What are the typical symptoms of GERD?

Acid reflux, heart burn and dysphagia (difficulty in swallowing).

How is GERD diagnosed in patients with above presentations?

Upper gastro-intestinal (GI) endoscopy is the first-choice procedure to diagnose the condition. There are the further tests that can be done for patients with persistent symptoms but normal endoscopy findings.

What are the likely complications of acid reflux?

The esophagus can develop sores (ulcers) or become narrow (stricture), and sometimes the patient can get a sore throat and inhale some secretions or food, causing pneumonia. There is also a very small (less than 1%) risk of developing a malignancy.

What is the first line of treatment?

Usually patients respond to medicinal treatment, such as antacids and drugs that reduce acid secretion.

When is the right time to have surgery?

If you do not respond to medical treatment, or your doctor is concerned about the esophagus becoming narrowed, or it looks abnormal, it may be recommended that you have surgery. Some patients also have difficulty lying down or sleeping at night and surgery may be the best option.

What is the best option for surgery?

Laparoscopic fundoplication (a type of key hole surgery) is the gold standard for treatment of severe GERD. This procedure involves wrapping the upper part of the stomach around the lower end of the esophagus. The operation only requires five small 5 mm to 10 mm incisions. Compared to conventional open surgery, the laparoscopic procedure causes much less trauma, a shorter hospital stay, and less blood loss. Most importantly, the long-term benefits of the laparoscopic surgery are the same as with the open surgery.

What are the complications?

Difficulty swallowing and gas bloating are the most likely problems after surgery (around 5% of patients). Most of these symptoms will resolve themselves after two or three months. A few patients (less than 1%) will need endoscopic dilatation.

How long is the hospital stay? How long is the operation?

The average hospital stay after a laparoscopic operation is about two to three days. The average operation time is about 90 minutes.

What do you do now?

You can talk with your primary care provider to see if you should be referred.