What is Severe GERD Surgery?
Severe GERD Surgery occurs when a patient redevelops severe symptoms of gastroesophageal reflux disease (GERD) after having an initial successful Antireflux procedure i.e. Nissen or Toupet fundoplication (wrap). Typically the patient notices the reoccurrence of symptoms of GERD that brought them to surgery the first time.
What causes Antireflux Surgery to fail?
It’s important to remember that Antireflux Surgery is a reconstructive procedure recreating a barrier between the esophagus and stomach. Unlike traditional general surgical procedures no body parts are removed (appendix or gallbladder). During the initial Antireflux Surgery the surgeon utilizes the stomach and muscles of the diaphragm to reconstruct the valve or lower esophageal sphincter (LES). In some people the tissue may stretch or give over time. In addition the majority of patients have a hiatal hernia. Some patients have a genetic predisposition to develop hernias because of weak fascia. This area of the body is dynamic, moving with every breath and this constant motion may be a factor in weakening the initial repair. The technique of the initial surgery may lead to recurrent GERD symptoms. For example the fundoplication (wrap) can be too tight or too long causing trouble swallowing (dysphagia), or too loose causing persistent esophageal reflux.
Symptoms and Diagnosis
Recurring symptoms of Severe GERD are the earmark of a Failed Antireflux Surgery. Some of these symptoms may include choking, coughing, aspiration, pneumonia, asthma, voice changes, recurrent sinusitis and heartburn. These symptoms may be particularly worse at night.
If a patient’s hiatal hernia comes back, and the wrap slips up above the diaphragm, they can develop a paraesophageal hernia. These hernias are at risk for strangulation. This potentially life threatening problem may produce symptoms of chest pain or trouble swallowing (dysphagia).
How is Failed GERD Surgery treated?
Failed Antireflux Surgery is treated with laparoscopic revision or redo surgery. In this procedure we correct the failed component or components of the initial Antireflux Surgery.