Treating heartburn with surgery
Often heartburn and gastro-oesophageal reflux disease ( GORD) can be managed medically. However, a small percentage of GORD sufferers do not respond to lifestyle changes or medical treatments and may require GORD surgery.
When is surgery necessary for GORD?
- When medical treatment or medication fail to control symptoms
- When the sphincter muscle is unable to work properly
- When oesophageal cancer develops from chronic GORD
If left untreated, chronic GORD can cause long-term complications
What is laparoscopic surgery for GORD?
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 GORD?
- 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 anti-reflux surgery for GORD?
Laparoscopic anti-reflux surgery is a minimally invasive procedure that corrects GORD by creating an improved valve mechanism at the bottom of the oesophagus, called Nissen fundoplication. To correct GORD, the surgeon wraps the upper part of the stomach - called the fundus - around the lower portion of the oesophagus. This creates a tight sphincter so that food will not reflux back into the oesophagus.
Who is a candidate for laparoscopic anti-reflux surgery?
GORD patients who meet the following criteria are likely candidates for laparoscopic anti-reflux surgery:
- Have not had previous abdominal surgery
- Have small hiatal hernias without complications of GORD
- Experience most symptoms of GORD 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 GORD 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. You would need to talk to your surgeon to see which is right for you.
Will laparoscopic surgery cure chronic heartburn?
Although most patients undergoing this procedure are initially cured of chronic heartburn, experts are not sure if this is a permanent cure. New devices and procedures are being studied to improve the benefit for those who are not able to find relief with lifestyle changes and medication.
Are there other treatment options for heartburn and GORD?
New techniques are being developed that involve the use of an endoscope (a thin, flexible, lighted tube) that is passed through the mouth and into the oesophagus. These include:
- Endoscopic injection of bulking agents – this narrows the gastro-oesophageal junction to help prevent acid leaking up from the stomach
- Endoluminal gastroplication – pleats (folds) are sewn into the lower oesophageal sphincter restricting how much it can open, and thus preventing acid leaking up from the stomach
- Endoscopic radiofrequency ablation – pulses of heat create scars that narrow the oesophagus helping to prevent acid leaking up from the stomach
- Endoscopic augmentation with hydrogel implants – similar to injection of bulking agents but using hydrogel instead