Laparoscopic Surgery for Gastroesophageal Reflux Disease (GERD) (Heartburn)

Heartburn is a common condition. In the pure medical sense, it is caused by stomach contents going back up into the esophagus (GERD). The stomach contains acid and enzymes which cause inflammation to the lining of the esophagus. Other symptoms can be chest pain, vomiting, hoarseness, chronic cough (especially at night) and asthma. Some patients have a hiatal hernia, as well. Treatments include lifestyle changes, medication, or surgery. The patient should consult his or her physician to determine the best treatment. If an operation is recommended, laparoscopic surgery is the treatment of choice for this illness.

What Causes GERD?

The most common reason for patients to develop heartburn or other symptoms of GERD is a defective lower esophageal sphincter (LES). The LES is a complex valve system at the lower end of the esophagus which, when functioning properly, prevents the acid and enzymes of the stomach from going up into the esophagus. There are other reasons for reflux that must be identified before having laparoscopic surgery. In general, symptoms are directly related to the amount of reflux present. This can be measured by preoperative tests. A hiatal hernia is frequently present in patients with GERD, and, if present, is repaired at the same time.

How is Laparoscopic Surgery for GERD Performed?

The laparoscope is a fiberoptic telescope that is connected to a high-resolution video camera. The images from the laparoscope are projected onto a television monitor viewed by the surgeon in the operating room. There are five small incisions made in order to complete the surgery. The abdomen is inflated with carbon dioxide gas to allow the surgeon an optimal view of the abdominal cavity and the area to be repaired. The gas is removed at the end of the procedure. The top part of the stomach is wrapped around the lower end of the esophagus (fundoplication). This produces an effective valve mechanism that stops the reflux of gastric contents into the esophagus. The small incisions are closed with either tape or absorbable sutures. If a hiatal hernia is present, it is repaired at the same time.

What Can I Expect After Laparoscopic Surgery for GERD?

Patients are able to drink clear fluids within four hours of surgery, and they will be out of bed walking the same evening. The majority of patients get pain relief with oral medication. A limited barium swallow x-ray is obtained the first day after surgery to ensure the proper position of fundoplication. The patient is usually discharged from the hospital the day after surgery, and is able to eat soft foods.

What Are The Benefits of Laparoscopic Surgery for GERD?

• Five small incisions (1/4 to 1/2 inch) cause less pain than a large abdominal incision.
• The patient is discharged the day after surgery 99% of the time.
• Most patients are back to normal activity within 10 days to two weeks.
• The operation is effective in relieving symptoms in approximately 95% of patients.

Am I a Candidate for Laparoscopic Surgery for GERD?

If your physician recommends surgery to relieve your symptoms, it is preferable to perform the operation using laparoscopic technology. A qualified laparoscopic surgeon should perform the surgery. Certain preoperative tests will be required to determine if you are a candidate for this procedure.