Surgical Treatment of GERD (Fundoplication)

Heartburn, acid belching, and pain behind the sternum may be manifestations of gastroesophageal reflux disease (GERD). In most cases, the symptoms can be controlled with medications, but sometimes medical treatment does not provide a lasting result. Then the doctor may recommend surgical intervention.

At the Oxford Medical center, operations are performed by experienced surgeons in a modern inpatient facility equipped with expert-class equipment. Make an appointment for a consultation to undergo an examination and determine the optimal treatment strategy.

According to the recommendations of the American College of Gastroenterology, antireflux surgery may be considered in cases of persistent symptoms, a complicated course of the disease, or a large diaphragmatic hernia. The final decision is made after a comprehensive examination.

In severe GERD, surgery may be recommended:

• persistence of heartburn, acid belching, regurgitation, and other symptoms despite correctly selected medication therapy;
• rapid return of symptoms after discontinuation of treatment or the inability to take medications for a long period due to contraindications or adverse reactions;
• severe heartburn after eating, nighttime reflux, or constant backflow of stomach contents, which significantly impair quality of life;
• severe esophagitis, ulcers, or narrowing of the esophagus as a result of prolonged inflammation;
• a large hiatal hernia, which disrupts the function of the natural antireflux mechanism.

The doctors at “Oxford Medical” emphasize: the insufficient effect of medications alone does not yet determine the need for surgery. The decision on surgical treatment is made only after a comprehensive examination, which makes it possible to assess the course of the disease, exclude other causes of the symptoms, and determine whether the operation will help a particular patient.

Fundoplication is not performed if the risk of the operation exceeds the expected benefit or if an examination reveals a disease that requires different treatment. Some contraindications are temporary: after the condition has stabilized, the possibility of surgery is evaluated again.

The main contraindications include:

• severe decompensated diseases of the heart, lungs, kidneys, or other organs, in which the patient cannot safely undergo general anesthesia;
• blood clotting disorders that cannot be corrected before the operation;
• acute infectious diseases and exacerbation of chronic diseases;
• achalasia and other pronounced disorders of esophageal motility that require a different treatment approach;
• malignant neoplasms of the esophagus or stomach, in which a different type of operation is required;
• pregnancy — planned intervention is usually postponed until the completion of pregnancy and postpartum recovery.

Before the operation, the contractile ability of the esophagus is necessarily assessed. Reduced motility does not always exclude fundoplication, but it may affect the choice of its type. The final decision on the surgical treatment of reflux is made after a comprehensive examination and assessment of surgical risks.

Before fundoplication, comprehensive diagnostics are performed. Depending on the symptoms, the results of previous examinations, and the patient’s condition, the following may be prescribed:

• gastroscopy — an endoscopic examination of the esophagus and stomach;
• 24-hour esophageal pH monitoring;
• esophageal manometry;
• contrast radiography of the esophagus and stomach;
• general and biochemical blood tests, a coagulation test, and a urine test;
• electrocardiography and an anesthesiologist consultation;
• other examinations according to indications.

The doctors at “Oxford Medical” recommend informing the surgeon during the preliminary consultation about chronic diseases, allergic reactions, and all medications that you take. Some medications may affect the action of anesthesia, blood clotting, and the course of the operation, so, if necessary, the doctor will adjust the regimen for taking them in advance.

Before the operation, it is necessary to follow a fasting regimen. Usually, light food is allowed no later than 6 hours before anesthesia, fatty or heavy food — no later than 8 hours before, and clear liquids without pulp or milk — no later than 2 hours before. Since the rules may be stricter in cases of reflux, the patient must follow the anesthesiologist’s individual instructions exactly.

Fundoplication is performed under general anesthesia. In most cases, a laparoscopic technique is used: the surgeon makes several small punctures in the abdominal wall, through which a laparoscope with a video camera and special instruments are inserted. An enlarged image of the surgical area is transmitted to a monitor.

The operation takes place in several main stages:

• the surgeon examines the lower part of the esophagus, the upper part of the stomach, and the diaphragm;
• if a hernia is present, returns the displaced part of the stomach to the abdominal cavity;
• if necessary, restores the normal size of the esophageal opening of the diaphragm;
• forms a complete or partial cuff from the upper part of the stomach around the lower part of the esophagus;
• fixes the tissues and checks the formed antireflux barrier;
• removes the instruments and sutures the punctures.

The formed cuff supports the lower esophageal sphincter and prevents the backflow of stomach contents. At the same time, it should not be too tight so that food can pass freely from the esophagus to the stomach.

The duration of the operation depends on the selected type of fundoplication, the presence of a diaphragmatic hernia, and the complexity of the clinical case. The intervention usually lasts about 1–2 hours. After the operation, the patient is transferred to an inpatient ward, where their condition is monitored around the clock by medical personnel.

After laparoscopic fundoplication, the patient usually stays in the hospital for 1–3 days. Already on the first day, it is recommended to get up and walk, gradually increasing activity.

After discharge, it is important to:

• care for the postoperative wounds in accordance with the surgeon’s recommendations;
• not take a bath, visit a swimming pool, or swim in open bodies of water until the wounds have completely healed;
• walk every day but avoid overexertion;
• not lift heavy objects or perform intensive physical exercises;
• take the prescribed medications and undergo a follow-up examination.

After the operation, the diet is temporarily changed because swelling in the area of the formed cuff may make it difficult for solid food to pass. In the first days, liquid dishes are consumed, and then the patient switches to homogeneous soft food. It is necessary to eat small portions 5–6 times a day, slowly and thoroughly chewing the food. Carbonated drinks, dry and solid foods, fresh bread, tough meat, and food that causes bloating are temporarily excluded.

During the first weeks, rapid satiety, bloating, and moderate discomfort during swallowing may occur. Usually, these manifestations decrease as the postoperative swelling subsides.

The doctors at “Oxford Medical” recommend seeking urgent medical help if the temperature rises, the pain intensifies, repeated vomiting, shortness of breath, inability to swallow water, or redness, swelling, or discharge from the postoperative wounds occur.

The cost of surgical treatment depends on the type of operation and the complexity of the clinical case. You can view the fundoplication prices here in advance. The doctor will provide you with more precise information regarding the specifics of the operation and the cost during the preliminary consultation.

At the “Oxford Medical” medical center, operations are performed by experienced surgeons using modern minimally invasive techniques and expert-class equipment. To schedule a consultation with a surgeon, leave a request on the website or call the contact center.

The information is for informational purposes and does not replace a doctor’s consultation.

Sources:

• American College of Gastroenterology
• Society of American Gastrointestinal and Endoscopic Surgeons
• United European Gastroenterology and European Association for Endoscopic Surgery