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Reflux Gets Robotic Treatment

Some 40 million Americans suffer from acid reflux, a condition in which stomach acid flows backwards into the esophagus, causing a painful burning sensation. For most, heartburn is only an occasional source of discomfort that can be treated with moderate lifestyle changes such as eating earlier (three hours before bedtime) and cutting back on “trigger” foods such as caffeine, alcohol, mint, citrus or heavy spices. Medications that suppress the production of gastric acid (proton pump inhibitors or PPIs) may also be prescribed to relieve symptoms.

Medication is effective for the vast majority of individuals with acid reflux. However, some people are averse to the lifestyle changes that are necessary to feel better, and some would prefer not to stay on medication indefinitely. For others, drug therapy simply does not work. Those with persistent symptoms often assume that their reflux is untreatable and something they just have to live with. But there are alternatives when all other options have proven ineffective.

Surgical intervention is advised only for the seven to nine percent of patients whose conditions do not improve with more conservative measures. “The biggest misconception is that reflux is caused by diet,” explains laparoscopic and general surgeon Kevin Gillian, MD. “The truth is that while medications that reduce stomach acid make most people feel better, they are still refluxing. Reflux is not caused by acid or what you eat. It’s a plumbing problem. There’s usually a structural or mechanical defect that’s causing the symptoms, and that’s what surgery can fix.”

The most common anatomical defect leading to acid reflux is hiatal hernia. A hiatal hernia occurs when the upper part of the stomach and the lower esophageal sphincter begin sliding upward through a gap in the diaphragm, the thin layer of muscle between the chest and abdominal cavity. Heartburn can also occur if the lower esophageal sphincter is weak, or if the lower esophageal muscles tend to relax unexplainably.

When considering reflux surgery, candidates must first undergo testing to rule out mitigating health risks and possible alternate causes of chest pain, such as cardiac disease. To qualify for surgery, a patient must have had a recent endoscopy and will need to undergo an Esophageal Function Test to evaluate the adequacy of esophageal contractions. In addition, a 24-hour pH-impedance test (which measures the flow of acid into the esophagus) to confirm that symptoms are related to reflux is often requested. Both of these tests are performed at the Heartburn Center at Virginia Hospital Center.

The gold standard for the surgical treatment of reflux and repairing hiatal hernias is called the Nissen fundoplication. It is one of many procedures now performed with the Hospital’s da Vinci® Robotic Surgical System. In the procedure, slender instruments inserted through five dime-sized incisions are used to repair and strengthen the natural one way valve that protects the esophagus from reflux. The robotic technology provides 3-D views inside the body and allows for more precise suturing in this anatomically challenging area.da Vinci® Robotic Surgical System

“The robotic platform allows me to do the same laparoscopic procedure I’ve been doing for the past 15 years with enhanced vision and more flexible instrumentation,” says Dr. Gillian, who holds advanced training in the field of robotic surgery. With da Vinci, the surgical repair takes a little less than two hours and requires one overnight stay in the Hospital. Patients are typically back to work in three days. “Typically once the structural problem is fixed, there is no need for continued medication or dietary restrictions,” he adds.

Nissen fundoplication can be performed using three different techniques, of which robotic-assisted laparoscopy is just one. The other two approaches utilized by Dr. Gillian— traditional laparoscopy and a new incisionless endoscopic procedure performed through the mouth—are also extremely effective. “Choosing the most appropriate procedure depends on the patient’s anatomy, degree of symptoms, previous surgical history, and other health factors,” says Dr. Gillian, who is specially trained in all three procedures. “It’s really just a matter of talking to each patient and figuring out the best option for the best results.”

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Where can I go to get help for my Heartburn/GERD?

The Heartburn Center at Virginia Hospital Center
1625 N. George Mason Drive, Arlington, VA 22205
Phone: 703.717.GERD (4373)
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Hernia & Heartburn Institute

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