What is Antireflux Surgery?
Antireflux Surgery is a laparoscopic procedure performed to treat Severe GERD. This is accomplished by repairing the hiatal hernia. The surgery consists of repairs to the barrier or valve between the esophagus and stomach and repair of the hiatal hernia if present. That valve is called the Lower Esophageal Sphincter, or LES.
Most cases of basic Gastroesophageal Reflux Disease, or GERD, respond well to medication and other conservative treatment. Those patients with GERD that doesn’t respond to treatment or that is made complicated by other conditions, may have Severe GERD or pathologic GERD.
In Severe GERD there is commonly both the presence of a hiatal hernia and a weak lower esophageal valve, or LES. About 80% of people with Severe GERD have a hiatal hernia. A hiatal hernia is is a weakness in the diaphragm – the muscle between the chest and the abdomen – where the stomach slips up above the diaphragm.
Who needs Antireflux Surgery?
Laparoscopic Antireflux Surgery is performed to treat patients with GERD that has proven unresponsive to other treatment options. Severe GERD Surgery is performed to treat Severe GERD by reconstructing the LES and by repairing the hiatal hernia.
What are the steps in Antireflux Surgery?
Reducing the Hiatal Hernia
One of the main components or steps in Antireflux Surgery or GERD surgery is to repair the hiatal hernia. Your surgeon will place the stomach back into its correct position, which is below the diaphragm.
Repairing the Hiatal Hernia
Once it’s in place, the hole created by the hernia will be sutured closed. A special surgical mesh will then be placed to prevent the hernia from returning.
Reconstructing the Valve
The next step in Antireflux Surgery is to reconstruct the LES, to make it function stronger as a valve. This is accomplished through a procedure called a procedure called a fundoplication or a wrap. Your surgeon will mobilize the fundus of the stomach, which is the upper portion of the stomach up near the diaphragm, and wrap it around the esophagus. This wrap increases the pressure zone of the valve and prevents reflux.
Different Wrap Methods
There are different wrap methods your surgeon may choose depending on your particular condition. A complete wrap, which is a 360 degree circle, is called a Nissen fundoplication. Another type of wrap is the Toupet or a partial wrap, which is between 270 and 300 degree wrap, and that type is used for people who have a weak esophagus. Other types of wrap methods exist, but all fundoplication methods are intended to increase the pressure zone of the valve.
After Surgery
Laparoscopic Antireflux Surgery is usually performed as an outpatient procedure with a 23 hour stay. Your doctor will prescribe a special diet and certain activity modifications that will help ensure the best results from your procedure. Many patients lose 7 to 10 pounds after surgery due to the diet change. Rest is an important part of recovery after this procedure. Your doctor will recommend waiting at least a week after surgery before performing any normal, day-to-day activities. Return to work time varies depending on your occupation, but the average is 12 days.