Should You Consider Surgery for GERD?
If you suffer from heartburn, you can take some comfort in knowing that most cases are treatable. When heartburn becomes more frequent that may be a strong indicator of a disease commonly known as acid reflux or GERD.
First course of action
Generally speaking, treatment for acid reflux involves lifestyle changes and medication. If, however, treatment doesn't work surgery may be an option.
When is surgery a good option?
The biggest percentage of people diagnosed with GERD will be able to manage their symptoms without surgery. That's the good news! However, continued heartburn that does not seem to respond to nonsurgical treatments may benefit from surgery. Other signs that surgery is necessary include severe inflammation of the esophagus, narrowing of the esophagus or a diagnosis of Barrett's esophagus.
A Nissen fundoplication is by far the most common procedure performed. It is done laparoscopically and 90 to 95% of patients experience good results. This is the best known procedure and has the highest rate of success, but is also the most invasive procedure, requiring incisions in the abdomen and a recovery period of 3 to 4 weeks.
Endoluminal procedures are a newer surgery option that is done through the mouth and does not require any incisions in the abdomen. However, this is not a good choice for the patient with a hiatal hernia or Barrett's esophagus. There is a 60 to 80% success rate when performed by an experienced surgeon. There is less pain and a faster recovery with this option as well, but because it is relatively new, the prediction for long-term success is still unknown. There are fewer surgeons available with experience and insurance companies usually do not cover this procedure.
The Linx Reflux System has been recently approved by the FDA. This procedure involves implanting, laparoscopically, a device around the end of the esophagus. It's done on an outpatient procedure basis. Because it is so new, this option is only available at a few select centers across the United States. It is not an option for those diagnosed with Barrett's esophagus or with a hiatal hernia that measures more than 3 cm.
The decision to undergo surgery is a serious one. Surgery of any kind carries risk to the patient. It is highly advised that all other noninvasive treatments be tried first before discussing the need for surgery.
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