GERD Surgery Q&A

An Interview about GERD Surgery with Dr. Michael O’Reilly of Phoenix of Marietta.

What does Antireflux Surgery consist of?

Most people with esophageal reflux (GERD) do not need surgery. Only 20% of patients with GERD have what I call pathologic GERD. These are the patients with persistent symptoms of GERD despite medications. All patients with severe GERD have a valve between the esophagus and stomach that does not work properly. That valve is called the Lower Esophageal Sphincter, or LES. Medications prescribed decrease the acid production in the stomach or helps the stomach empty. None of the medications increase the LES or valve function. In addition the great majority of people with pathological acid reflux have a hiatal hernia. None of the medications repairs the hiatal hernia.

The two main steps in Antireflux Surgery are:

  1. Reconstruct the valve (LES): The main step is to reconstruct the valve (LES) to make it stronger. This is accomplished by performing a procedure called a fundoplication or a wrap. The fundus of the stomach is mobilized, which is the upper portion of the stomach up near the diaphragm, and it is wrapped around the distal esophagus. The wrap or fundoplication increase the pressure zone of the valve (LES) allowing it to function properly.
  2. Repair the hiatal hernia: The majority of people with pathological acid reflux have a hiatal hernia. A hiatal hernia is a weakness in the diaphragm – the muscle between the chest and the abdomen – where the stomach slips up above the diaphragm into the chest. During the repair the stomach is pulled back below the diaphragm. Stitches are placed in the diaphragm to close the hiatal hernia defect. Next I place mesh over the stitches in the diaphragm to help prevent recurrence of the hernia.