What are the surgical treatments for GERD?
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. Surgical management includes Stretta procedure, the incisionless TIF procedure, laparoscopic Nissen fundoplication, Robotic Nissen fundoplication and the LINX procedure.
Stretta Therapy is a minimally invasive, outpatient procedure for GERD that is done via endoscopy so there are no incisions or scars as a result of the procedure. The procedure takes about one hour and patients return to normal activities within 1-2 days.
The Stretta procedure utilizes radiofrequency energy (RF), an energy waveform which is used in many medical specialties for coagulating or treating tissues. RF has been used in surgery for nearly 100 years. The Stretta procedure was cleared by the FDA for the treatment of GERD in April 2000, and uses RF to tighten the valve between the stomach and the esophagus which has been proven to reduce GERD symptoms.
In clinical trials evaluating the Stretta procedure, up to 93% of patients were satisfied with the outcome of their Stretta Therapy, and up to 86% of patients remained off daily GERD medications four years after their Stretta procedure. Stretta has been shown to not only reduce acid exposure, but to improve the muscle structure of the lower esophagus which reduces the random relaxations of the esophagus that are known to cause GERD symptoms. Watch the video >
Transoral Incisionless fundoplication (TIF)
TIF is a surgical procedure performed through the mouth and without incisions; it employs the EsophyX device to create an esophagogastric fundoplication that is up to 270° and 2-3cm in length. A unique form of Natural Orifice Surgery (NOS), TIF represents the next step in the field of minimally invasive surgery and the treatment of GERD.
Laparoscopic Nissen fundoplication
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.
Robotic Nissen fundoplication
The Robotic Nissen fundoplication 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.
“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 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.
The LINX procedure
The new LINX procedure allows for surgical correction of the defective sphincter with minimal disruption of the regional anatomy. Medical engineers created a bracelet consisting of a series of magnetic beads that can be placed around the lower esophagus to augment the physiologic sphincter and protect the patient from reflux. Because the beads are able to slide independently from each other it creates a dynamic valve that can expand to allow for swallowing or belching but resists opening to typical gastric reflux. Consequently the side effects after surgery are less but the control of GERD that surgery offers is maintained.
The Heartburn Center at Virginia Hospital Center under the direction of Dr. Gillian is the first and currently only center in Virginia and Washington DC to offer the LINX procedure to patients.
In the News | Patient Success Story
Where can I go to get help for my Heartburn/GERD?
For heartburn testing:
The Heartburn Center at Virginia Hospital Center
1625 N. George Mason Drive, Arlington, VA 22205
Phone: 703.717.GERD (4373)