Laparoscopic Fundoplication or Anti Reflux Surgery is the Best Surgical Option for Failed Treatment

GERD patients who are not getting benefitted by life style modifications and medications will require reference to surgical gastroenterologist to assess for anti reflux surgery (Nissen fundoplication).

Gastro esophageal reflux disease (GERD) is a condition which occurs due to the reflux of acids from the stomach back into the esophagus (food pipe) due to improper functioning of lower esophageal sphincter (LES) located between stomach and esophagus. This resultant, harsh acid causes a burning sensation (Heart Burn) in the area between the ribs or just below the neck which may sometimes radiate along the chest into the jaws and throat.

Commonly experienced complaints may include nausea, vomiting, regurgitation, difficulty in swallowing, chronic cough with or without wheezing.

Patients with mild GERD could be treated with lifestyle modifications such as avoiding alcohol, avoiding spicy & salty food, losing weight, quit smoking, using 2-3 pillows while sleeping and practicing proper sleeping patterns whereas some may require medications like antacids, H2 blockers or proton pump inhibitors (PPIs).

However, patients who are not responding to both these ways of treatment will require surgical interventions. The latest and the most preferred surgical therapy for GERD includes Fundoplication Surgery, which can be done either as an open procedure or laparoscopically. The primary objective of fundoplication is to reinforce the LES to redevelop the barrier which will prevent the occurrence of reflux back from the stomach.

The procedure is carried out by wrapping a portion of the stomach around the bottom part of the esophagus in order to strengthen the affected LES valve. Being the commonest and most preferred type of surgery, Nissen fundoplication uses a method where the stomach itself is wrapped 360 degrees around the lower esophagus so that acid reflux will completely get halted. Also, there are other types of surgeries which do not involve a complete wrap up around the stomach. However, Nissen fundoplication is known to be the treatment of choice for GERD.

Similar to most surgeries done these days, fundoplication can also be performed using a minimally invasive method of laparoscopy in which a narrow tube-like camera is inserted into the abdomen through small incisions on the abdominal wall.

The major benefits of this minimally invasive technique involves,

• Minimal pain
• Short duration of hospital stay
• Quick recovery
• Tiny scars which are rarely visible
• A very low risk of wound infections and hernias

According to research studies, following the laparoscopic anti-reflux surgery, both short-term (1–5 years) and long-term follow-ups (5–10 years) have proved that majority of patients have shown an effective improvement, a high satisfaction with an enhanced quality of life. More importantly, all most all the patients have taken off the anta-acid drugs, they have been using for a long period of time, after the surgery. Interestingly, most patients have consistently answered that they would not think twice to go through the anti-reflux surgery if necessary due to its extremely comfortable nature.

However, even if complications like adverse effects of general anesthesia, bleeding, infection or injury to nearby organs are possible, the surgery when performed by an experienced Laparoscopic GI surgeon is exceptionally safe where life threatening outcomes are highly unusual.

Laparoscopic fundoplication or anti reflux surgery is known to be the best surgical option available for failed treatment of GERD and large hiatal hernias due to its comparatively effective consequences.

Dr. Nitish Jhawar is a Senior Laparoscopic Surgeon at Fortis Hiranandani hospital and Neoalta Specialty Clinic, Vashi, Navi Mumbai with 15 years of expertise.