Treating Heartburn With Surgery
For most people, heartburn is a treatable symptom. Frequent heartburn may indicate acid reflux or gastroesophageal reflux disease, also known as GERD. When treatment doesn't work and heartburn is severe despite lifestyle changes, surgery may be an option. It may also be an option if GERD causes other medical problems. Minimally invasive procedures using endoscopy are also available to treat acid reflux.
When to Consider Surgery for GERD
The vast majority of people with GERD can control heartburn symptoms adequately without surgery. A few people, though, still have acid reflux symptoms even after treating them with medications, lifestyle, and diet changes. For these people, surgery helps.
Heartburn that doesn't go away despite maximum non-surgical treatment is the most common reason to consider surgery for GERD. Other situations where surgery may be an option include:
- Severe inflammation of the esophagus, called esophagitis.
- A narrowing, known as a stricture, of the esophagus that's not caused by cancer.
- Barrett's esophagus, which is a change in the cells of the esophagus because of acid reflux.
All surgical procedures carry risk. So generally, GERD surgery should be considered only after other treatment has not worked and tests suggest there's a good chance surgery will succeed.
Most people, if not everyone, considering surgery for GERD will first undergo endoscopy. Many will also have tests to check the muscle function of the esophagus. These tests can include esophageal manometry and esophageal motility studies.
Types of Surgery for GERD
The main surgery performed for persistent heartburn is called fundoplication. The surgery involves several steps:
- The surgeon first cuts into the abdomen. He or she will either make one large incision for open surgery or a few small incisions for laparoscopic surgery.
- In laparoscopic fundoplication, the surgeon operates from outside the body using tools inserted into the abdomen. During open fundoplication, he or she operates directly using his or her hands.
- The surgeon wraps the top part of the stomach around the lower part of the esophagus and sews it in place.
- This tightens the lower esophagus. That helps prevent acid from moving from the stomach into the esophagus and causing acid reflux.
In most cases, the top part of the stomach is wrapped all the way around the esophagus. People with other problems in the esophagus besides reflux may undergo a modified surgery with only a partial wrap.
Laparoscopic surgery requires a shorter recovery time with less pain than open surgery. Plus it leaves no large scar. When performed by an experienced surgeon, laparoscopic surgery works at least as well as traditional open surgery. For this reason, laparoscopic fundoplication is usually the best option for GERD surgery if an experienced surgeon is available.
In some cases, symptoms may return or develop and additional surgery may be needed.