Treating Heartburn With Surgery

Often heartburn and gastroesophageal reflux disease (GERD) can be managed medically; however, a small percentage of GERD sufferers do not respond to lifestyle changes or drug treatments and may require GERD surgery.

Surgery to treat GERD is controversial. Newer studies are questioning whether surgery is better than medical therapy and if the procedure truly cures the condition.

When Is Surgery Necessary for GERD?

• When medical or drug treatment has failed to control symptoms.
• When the sphincter muscle is unable to work properly.
• When patients can't afford or do not want to take medication to treat their symptoms.
• When esophageal cancer develops from chronic GERD.

If left untreated, chronic GERD can cause long-term complications

What Is Laparoscopic Surgery for GERD?

Laparoscopic surgery is an alternative to traditional surgery, which usually requires long and deep incisions and a lengthy recovery. Laparoscopic surgery, which is minimally invasive, eliminates the need for large incisions. A laparoscope is a thin, telescope-like instrument with a miniature video camera and light source on the end, which transmits images to a video monitor. The surgeon watches the video screen to perform the procedure using special instruments that pass through small incisions in the patient's body.

What Are the Benefits of Minimally Invasive Surgery for GERD?

• Smaller incisions, and therefore, little or no scarring
• Shortened hospital stay
• Less risk of infection or bleeding after surgery
• Faster recovery
• Less pain
• Faster return to normal activities
• Lower overall costs

What Is Laparoscopic Antireflux Surgery for GERD?

Laparoscopic antireflux surgery is a minimally invasive procedure that corrects GERD by creating an improved valve mechanism at the bottom of the esophagus. To correct GERD, the surgeon wraps the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This creates a tight sphincter so that food will not reflux back into the esophagus.

Who Is a Candidate for Laparoscopic Antireflux Surgery?

Reflux patients who meet the following criteria are likely candidates for laparoscopic antireflux surgery.

• Have not had previous abdominal surgery
• Have small hiatal hernias without complications of GERD
• Experience most symptoms of GERD when lying down
• Have no history of bleeding disorders
• Are not pregnant
• Have no other underlying medical problems, such as heart or lung disease

Not all GERD patients are candidates for laparoscopic surgery. More invasive procedures, such as laparotomy (requires opening the abdomen) and thoracotomy (opening the chest), may be necessary for some people. Talk to your doctor to see what's right for you.

Will Laparoscopic Surgery Cure Chronic Heartburn?

Although more than 90% of patients undergoing this procedure are initially cured of chronic heartburn, experts aren't sure if this is a permanent cure. New devices and procedures are being studied to improve the benefit to those who are not able to find relief with medications.

Are There Other Treatment Options for Heartburn and GERD?

New techniques are being developed that involve the use of an endoscope (a thin, flexible, lighted tube) which is passed through the mouth and into the esophagus. One such procedure is the Stretta procedure. Like laparoscopic surgery for heartburn and GERD, it is not yet clear if these procedures will lead to a permanent cure.

Reviewed by the doctors at The Cleveland Clinic Department of Gastroenterology & Hepatology.