Gastroesophageal reflux disease (GORD) is a medical condition where acid from the stomach moves up into the food pipe (oesophagus). It can cause chest pain, heartburn, and long-term damage if left untreated.
GORD is usually managed with lifestyle changes and medications. However, reflux surgery may be necessary if GORD symptoms, such as heartburn, chest pain, and hoarseness, persist or worsen. Other underlying causes may require surgery if responsible for the persistent reflux.
Below, we discuss acid reflux surgery, covering the indications, surgical options, and recovery. We will also provide information on testing and treatment for reflux disease.
In this guide:
- When to Consider Surgery
- Types of Acid Reflux Surgery
- Recovering from Reflux Surgery
- Potential Risks of Anti-Reflux Surgery
When to Consider Surgery
Surgery is always a last resort. It’s reserved for cases of GORD that will not be resolved with conventional treatment. Your doctor or surgeon may expect you to have been diligent with lifestyle changes and tried medications like H2 blockers and PPIs first. Only when these other (less risky) options have failed is surgery considered.
Treatment-resistant reflux isn’t the only indicator for surgery. GORD complications are another potential factor. Persistent acid reflux causes inflammation of the oesophagus. If left untreated, this can lead to ulcers, bleeding, and sometimes cancer. Surgery may be necessary to relieve this discomfort.
Lastly, a hiatus hernia is an indication for surgery. This refers to a condition where part of the stomach sits above the diaphragm. Usually, the diaphragm prevents acid from entering the oesophagus. However, due to pressure within the abdomen pushing the stomach upwards, this is no longer the case. Most hiatus hernias don’t require surgery – but it can sometimes be necessary.
Pros of Reflux Surgery
- Effective Symptom Relief: Provides long-term relief from acid reflux symptoms like heartburn and regurgitation.
- Reduced Medication Dependence: Minimises or eliminates the need for daily medications, such as proton pump inhibitors (PPIs).
- Improved Quality of Life: Enhances comfort during eating and sleeping by addressing the root cause of reflux.
- Treats Underlying Issue: Repairs structural problems, such as a hiatal hernia, that contribute to acid reflux.
Cons of Reflux Surgery
- Surgical Risks. Potential complications include infection, bleeding, or anaesthesia reactions.
- Post-Surgical Side Effects. May lead to problems with swallowing, bloating, or inability to burp or vomit.
- Recovery Time. Recovery times and lifestyle changes may be unsuitable for some people.
Types of Acid Reflux Surgery
Laparoscopic Fundoplication
The most common form of acid reflux surgery. Performed as an inpatient procedure, it takes around 1 ½ hours to complete and requires general anaesthesia. The surgeon makes several small incisions in the abdomen to insert a camera and instruments.
The surgeon takes the upper portion of the stomach (fundus) and wraps it around the lower oesophagus to strengthen the lower oesophageal sphincter (LOS), the ring of muscle that usually prevents stomach acid from flowing up into the oesophagus.
During this procedure, the surgeon may repair a hiatus hernia. The stomach is moved down below the diaphragm, the oesophagus is straightened, and the hole in the diaphragm is closed with sutures or surgical mesh.
Most people who undergo this surgery can go home the same day or after a night of observation. The most common side effect is difficulty swallowing, which usually lasts a few days.
Transoral Incisionless Fundoplication
Similar to laparoscopic fundoplication, this procedure requires no incisions; instead, the surgeon accesses the stomach via the mouth. A device called the EsophyX® is used. It is inserted down the throat to the point where the stomach and oesophagus meet (the gastroesophageal junction). Using a video camera, the surgeon creates tissue folds around the LOS to tighten and repair it.
As before, patients can go home immediately after the surgery. Patients may notice a sore throat, shoulder pain, difficulty swallowing, and some nausea and vomiting. Usually, this subsides quickly.
LINX® Reflux Management System
The final type of anti-reflux surgery is the newest. It uses a small, ring-like band of magnetic beads that are placed around the oesophagus above the stomach. The beads help keep the sphincter closed. It involves several small incisions in the abdomen and is performed laparoscopically.
The procedure is not suitable for people with a hiatus hernia larger than 3 cm. It takes less than an hour to complete, and people can return home on the same day.
Recovering from Reflux Surgery
Recovery is different from patient to patient. It depends on your age, health status, and type of surgery. Most patients can return from the hospital on the same day or the next day. Some side effects are normal, including difficulty swallowing, nausea and vomiting, sore throat, and general discomfort. This should subside within a few days.
Depending on the procedure, you may have to adjust your diet for several days. Eating softer foods or liquids can be advised for certain surgeries. The LINX Reflux Management System is notable for allowing solid foods straightaway.
Potential Risks of Anti-Reflux Surgery
Every surgical procedure carries risks. There is a small chance of the following complications:
- Pain
- Bleeding
- Infection of the surgical site
- Scarring
- Blood clots (DVT – deep vein thrombosis)
Get Diagnosed with Reflux Disease
Persistent heartburn, chest pain, hoarseness, and coughing can indicate reflux disease. The only reliable form of diagnosis is to measure your oesophageal pH. A reflux test involves inserting a pH monitor into your oesophagus for 24 hours to detect any changes in the pH level. If the pH drops during this time, it’s diagnostic for reflux disease.
Scheduling reflux monitoring doesn’t have to be complicated. We’re experts in diagnosing reflux disease using our advanced monitoring system. We’ll explain the results and advise you on the next steps if you receive a confirmation of reflux disease.
Ready to understand your symptoms? Call us on 0207 486 7777 or send us an email at admin@thefunctionalgutclinic.com.