Surgery for Gastroesophageal Reflux Disease

Often, lifestyle changes and medication effectively manage gastroesophageal reflux disease, or GERD. But doctors at NYU Langone may recommend surgery if GERD symptoms, such as heartburn, chest pain, and hoarseness, persist or if diagnostic tests show that GERD is caused by a hiatal hernia—a hole in the diaphragm that allows part of the stomach to enter the chest cavity. 

At NYU Langone, our gastrointestinal surgeons perform a very high volume of successful GERD-related surgeries each year, making NYU Langone one of the area’s most trusted destinations for GERD treatment. 

Because GERD is caused by dysfunction of the lower esophageal sphincter—a ring of muscles acting as a valve between the stomach and the esophagus, which is the tube that carries food from the mouth to the stomach—surgery is designed to reinforce and strengthen the esophageal sphincter. This enables it to function properly, ensuring that the valve stays closed and doesn’t allow acid and other stomach contents to flow up into the esophagus.

The types of surgery performed at NYU Langone include laparoscopic fundoplication, transoral incisionless fundoplication, and the LINX® Reflux Management System.

Laparoscopic Fundoplication

The most commonly performed surgery for GERD, laparoscopic fundoplication is an outpatient procedure that takes about an hour and a half to complete and requires general anesthesia. During the procedure, the surgeon makes four small incisions in the abdomen and inserts a flexible tube with a tiny camera at the tip to help guide the surgeon throughout the surgery.

The surgeon then takes a portion of the upper stomach, called the fundus, and wraps it around the bottom of the esophagus to form a valve between the stomach and the esophagus. This strengthens the lower esophageal sphincter, which prevents stomach acid from flowing up into the esophagus.

There are two main variations: the Nissen fundoplication, in which a portion of the stomach is wrapped completely around the esophagus, and the Toupet fundoplication, in which a portion of the stomach is wrapped partway around the esophagus. Both procedures are effective. Your surgeon reviews your medical history and diagnostic test results to determine which is appropriate for you.

A surgeon can also repair a hiatal hernia during a laparoscopic fundoplication. To do so, the surgeon gently pushes the top of the stomach back down below the diaphragm, straightens the esophagus, and then closes the hole in the diaphragm with sutures, and sometimes surgical mesh, to ensure that the stomach stays in place.

People treated with laparoscopic fundoplication can usually go home the day of surgery but occasionally after overnight observation. Your doctor may ask you to consume only liquids for a week or two after surgery and then gradually introduce soft foods.

Research has shown that the vast majority of people who undergo laparoscopic fundoplication no longer require medication for the treatment of GERD. People experience symptom relief within as little as a week after surgery. Some experience a mild recurrence of symptoms many years after surgery, usually treated with the occasional use of medication.

The most common side effect of laparoscopic fundoplication is difficulty swallowing after surgery. This lasts for only a few weeks, until your esophagus slowly adjusts. In addition, the repaired esophageal muscle is initially so strong that gas may become trapped in the digestive system, leading to bloating and flatulence. These symptoms usually subside after a few weeks, when the muscles relax after surgery.

Transoral Incisionless Fundoplication

Transoral incisionless fundoplication is a minimally invasive procedure for GERD. Unlike the laparoscopic fundoplication that requires incisions in the abdomen, transoral incisionless fundoplication is performed through the mouth, without incisions.

During the procedure, a surgeon inserts a device called the EsophyX® through the mouth, gently advancing it down the throat and through the esophagus to the area where it meets the stomach, known as the gastroesophageal junction. With the guidance of a video camera located inside the EsophyX®, the surgeon creates sutures and tissue folds around the lower esophageal sphincter muscle, ultimately tightening and repairing it.  

This procedure is performed using general anesthesia and takes up to one hour. You can typically go home the day after surgery and resume your normal activities within a few days. Temporary side effects include sore throat, shoulder pain from nerve irritation, difficulty swallowing, and, possibly, nausea or vomiting. Recent studies show that most people no longer need to take GERD medications after transoral incisionless fundoplication, and the majority of people are still not taking medication two years after the procedure.

LINX Reflux Management System

The LINX® Reflux Management System is one of the newest available devices for the treatment of GERD. NYU Langone was one of the first places in the New York metropolitan area to offer this procedure, and our doctors consider it one of the safest and most effective surgical treatments for GERD.

The LINX® system uses a small, ring-like, flexible band of magnetic beads enclosed in titanium that’s placed around the esophagus just above the stomach. The magnetic attraction between the beads helps to keep the lower esophageal sphincter closed, preventing the contents of the stomach from flowing back into the esophagus.

LINX® system surgery is performed using laparoscopy, which requires smaller incisions than traditional surgery. A surgeon makes several small incisions in the abdomen, inserting a flexible tube with a tiny camera at the tip that guides him or her throughout the procedure. The surgeon then measures the esophagus and sizes the LINX® system accordingly before attaching the device to the bottom of the esophagus.

Surgery takes place using general anesthesia and typically lasts less than one hour. Most people return home the same day as the surgery and can resume a typical, solid diet immediately.

The most common side effect of the LINX® system is discomfort while swallowing. This lasts only a few weeks, as your esophagus slowly adjusts to the ring. Eventually, the discomfort goes away and swallowing feels normal again. New studies show that the vast majority of people who use the LINX® system need no medications and experience no GERD symptoms for at least the next five years.

The LINX® system is not recommended when GERD is caused by a hiatal hernia larger than 3 centimeters. A larger hiatal hernia requires surgical repair, which can be done during either of the fundoplication procedures.

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