The first approach to managing GERD is always behavioral/dietary modification, such as avoidance of eating just before lying down for bed, avoidance of certain foods and weight loss. Most patients are ultimately started on medications like antacids (eg. TUMS), H2 Blockers (eg. Pepcid) or proton pump inhibitors (PPIs: eg. Nexium, Prilosec), which can help lessen the severity of heartburn. However, they do not work for everyone, and as heartburn becomes more chronic or severe, many patients are not comfortable with the idea of taking these medications for the rest of their lives. It is important to note that most PPIs and other acid suppression medications are only indicated for up to 8 weeks of chronic use. This means that the studies used to gain FDA approval for these medications only studied their safety and effectiveness out to 8 weeks. However, there are recent studies that suggest long-term PPI use can be associated with conditions such as osteoporosis, kidney disease and even early-onset dementia. This has led to an increase in patient demand for better alternatives to daily medication for GERD.
Surgical Treatment Options for GERD
There are several reasons to consider anti-reflux surgery:
- Severe GERD symptoms that are not relieved by medication
- Severe GERD symptoms that are well-controlled by medication, but the patient would like to come off medication due to concern of side effects
- Patients with any degree of GERD symptoms who have a GERD-related complication such as ulceration, stricture, or Barrett’s Esophagus
- Patients with asymptomatic hiatal hernia, resulting in either GERD symptoms or difficulty swallowing food (dysphagia)
After surgery, GERD patients typically report a reduction in severe heartburn impacting their daily lives, and a marked improvement of quality of life. This includes less pain, regaining or expanding their food choices, improved pulmonary symptoms and better sleep. In most patients, over 90% can stop taking reflux medications altogether.
There are several options available for the surgical treatment of GERD.
What types of GERD surgery are available?
At MIIS, we offer the most minimally invasive surgical treatment options for our patients including a hiatal hernia repair, fundoplication or LINX device. These procedures are typically performed laparoscopically or robotically through several small incisions. This allows patients to resume normal activities much more quickly than if we performed these procedures open, or with one large incision in the abdomen. Laparoscopy is also more cosmetically appealing, as many of the incisions are barely visible once they complete the healing process. We also often perform robotic surgeries, which can offer even better visibility than laparoscopic surgery.