Surgical Treatment of GERD

Which procedure is best for you?

C. Daniel Smith, MD

Nissen Fundoplication• Most common procedure performed

• Most often done laparoscopically

• Open approach may be recommended for redo surgery or complex hiatal hernia

• With an experienced surgeon, 90-95% of patients have good control of typical GERD symptoms

Endolumenal Procedures• Newer procedures performed through

the mouth and without any incisions in abdomen

• Esophyx TIF and Stretta are only ones currently available in U.S.

• Not an option in those with moderate to large hiatal hernia or Barretts esophagus

• With an experienced surgeon, 60-80% of patients have control of typical GERD symptoms

Linx Reflux System• Recently approved by FDA

• Implanted laparoscopically around end of esophagus

• Outpatient procedure

• Not an option in those with Barretts or more than 3 cm hiatal hernia

• Only available at select centers

Nissen Fundoplication

• Best studied and most common procedure performed

• Highest rate of success (90-95%)

• Hiatal hernia is fixed

• Best success with atypical GERD symptoms (80-90%)

• Most invasive procedure requiring incisions in abdomen

• Full recovery takes 3-4 weeks

• Failure requires more complex redo surgery

• Outcome dependent on surgeon skill and experience

Pros Cons

Endolumenal Procedures

• No incisions

• Less pain

• Faster recovery

• If fails, still candidate for laparoscopic Nissen

• New - unknown long term success

• Lower initial and early success rates (60-80%)

• Unknown results with atypical GERD symptoms

• Not many surgeons with experience

• Many insurance companies do not cover

Pros Cons

Linx Reflux System

• Mechanically very similar to native esophageal sphincter

• No need to alter diet after surgery

• Minimal side effects

• If fails, still candidate for laparoscopic Nissen

• New - unknown long term success

• Not an option in Barretts or more than 3 cm hiatal hernia

• After Linx implanted patient can not have an MRI

• Not widely available

Pros Cons

Nissen Fundoplication

• 60-90 minute procedure

• 1 night stay in hospital

• Risk of complication less than 1%

• No heavy lifting for 4 weeks after surgery

• Liquid/soft food diet for 4 weeks after surgery

• Most are able to return to work 2-4 weeks after surgery

• OK to shower the day after surgery

• OK to drive when no longer using prescription pain medicine

• No special help needed at home

Details

Endolumenal Procedures

• 45-60 minute procedure

• 1 night stay in hospital

• Risk of complication less than 1%

• No heavy lifting for 4 weeks after surgery

• Liquid/soft food diet for 2 weeks after surgery

• Most are able to return to work 1-2 weeks after surgery

• OK to shower the day after surgery

• OK to drive when no longer using prescription pain medicine

• No special help needed at home

Details

Linx Reflux System

• 30-45 minute procedure

• No overnight stay

• Less than 0.1% chance of complication

• Maintain regular diet immediately

• Most are able to return to work 1-2 weeks after surgery

• OK to shower the day after surgery

• OK to drive when no longer using prescription pain medicine

• No special help needed at home

Details

GERD Definitions

Typical GERD SymptomsHeartburnRegurgitationChest pain

Atypical GERD SymptomsCoughLaryngitisSore throatAsthma