What are the surgical treatments for GERD?

If your symptoms do not improve with lifestyle changes or medications, you may need additional tests.

• Barium swallow radiograph uses x-rays to help spot abnormalities such as a hiatal hernia and other structural or anatomical problems of the esophagus. With this test, you drink a solution and then x-rays are taken. The test will not detect mild irritation, although strictures—narrowing of the esophagus—and ulcers can be observed.
• Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor's office. The doctor may spray your throat to numb it and then, after lightly sedating you, will slide a thin, flexible plastic tube with a light and lens on the end called an endoscope down your throat. Acting as a tiny camera, the endoscope allows the doctor to see the surface of the esophagus and search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD.
  
  The doctor also may perform a biopsy. Tiny tweezers, called forceps, are passed through the endoscope and allow the doctor to remove small pieces of tissue from your esophagus. The tissue is then viewed with a microscope to look for damage caused by acid reflux and to rule out other problems if infection or abnormal growths are not found.
• pH monitoring examination involves the doctor either inserting a small tube into the esophagus or clipping a tiny device to the esophagus that will stay there for 24 to 48 hours. While you go about your normal activities, the device measures when and how much acid comes up into your esophagus. This test can be useful if combined with a carefully completed diary—recording when, what, and amounts the person eats—which allows the doctor to see correlations between symptoms and reflux episodes. The procedure is sometimes helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.

The perfect diagnostic test for GERD does not exist. The tests mentioned above all have their strengths and weaknesses. It often takes a combination of tests and physician evaluations to accurately determine the cause of symptoms and to design and implement an appropriate therapy to control those symptoms and repair any damage from chronic reflux.

Surgical Options

Surgery is an option when medicine and lifestyle changes fail to successfully manage the symptoms and damage associated with GERD. The procedures utilized are designed to correct the mechanical/physical defect that allows reflux to occur. Surgery is also chosen by some patients as reasonable alternative to a lifetime of drugs and lifestyle restrictions.

The Nissen Fundoplication is considered the "gold standard" for controlling reflux and repairing hiatal hernias. During this procedure, the hiatal hernia is repaired and the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen the sphincter, preventing acid reflux.

The Nissen fundoplication may be performed with either open surgery or minimally invasive surgical techniques (laparoscopic surgery). During a laparoscopic Nissen fundoplication small cameras and instruments are utilized to perform the repair through very small incisions. The small incisions greatly reduce the post-operative pain and allow for a much faster recovery. When performed by experienced surgeons, laparoscopic fundoplication is safe and effective in people of all ages, including infants. The procedure is reported to have the same results as the standard open fundoplication. Most people can leave the hospital after an overnight stay and return to work in 1 to 2 weeks. It is one of many procedures now performed with the Hospital’s da Vinci® Robotic Surgical System. More importantly, because the reflux is controlled, medications for GERD are usually no longer needed. Reflux Gets Robotic Treatment > 

Endoscopic techniques used to treat chronic heartburn include the Bard EndoCinch system, NDO Plicator, and the Stretta system. These techniques require the use of an endoscope to perform the anti-reflux operation. The EndoCinch and NDO Plicator systems involve putting stitches in the lower esophageal sphincter to create pleats that help strengthen the muscle. The Stretta system uses electrodes to create tiny burns on the lower esophageal sphincter. When the burns heal, the scar tissue helps toughen the muscle. These devices have not shown an ability to control GERD long term.