Surgery for Heartburn (GERD, Reflux)
A condition you know by its common name, heartburn, is also called “gastroesophageal reflux disease” or “G.E.R.D.”, which is a shorter way of saying the medical term.
You probably have heartburn or GERD from time to time. But if you have it often, your doctor might recommend surgery for this condition if your GERD does not go away with other treatments. This surgery is called “minimally-invasive anti-reflux surgery.”
This article tells you about GERD and your treatment options, including surgery. You will learn:
- About gastroesophageal reflux disease (GERD)
- Your treatment options, including medicine and surgery
- How GERD surgery is done
- How most people do after having this surgery
- What to expect if you choose to have surgery
What is Gastroesophageal Reflux Disease (GERD)?
GERD is a condition that happens when some of your stomach juices flow back into your esophagus (the tube that connects your mouth with your stomach). It is a very common condition. Many adults in the United States have heartburn or GERD at least once a month.
Heartburn can be a harsh, burning sensation in the area between your ribs or just below your neck. You might also feel it in your chest, throat or neck. Other symptoms can include vomiting, feeling food or liquid coming back up into your throat or mouth, trouble swallowing, and coughing or wheezing often.
When you eat, food travels from your mouth to your stomach through a tube called the esophagus. You have a small ring of muscle at the lower end of the esophagus called the lower esophageal sphincter, or LES. This valve opens to let food into the stomach and then closes behind it. Normally, this valve closes immediately after you swallow. This keeps the stomach juices, which contain a lot of acid, from flowing backwards into the esophagus.
GERD happens when the LES valve does not work properly. This allows acid to flow backwards and burn the lower esophagus. Your esophagus becomes irritated and inflamed, and the acids can eventually damage it. The cells that line the inside of the lower esophagus can start to change as a result of the constant contact with acid stomach juices. Doctors call this “Barrett’s esophagus,” and having it raises your risk of getting cancer in the area.
What Causes GERD?
Several things can cause GERD. They include:
- Having a naturally weak LES/valve – The muscle that closes the esophagus
- Having a very full stomach
- Eating fatty or spicy foods
- Taking certain medicines
- Wearing tight clothing, such as tight belts or waistbands
- Smoking or drinking alcohol
- Exercising vigorously
- Changing positions – Such as bending over or lying down after eating
You might also have something called a “hiatal hernia.” In this condition, the top part of your stomach bulges into your chest area. This can also cause GERD. Surgery for GERD also fixes a hiatal hernia if you have one.
Example of hiatal hernia:
Your GERD Treatment Options
Treatments for GERD include lifestyle changes, diet changes, medicines, and surgery. You will probably try these one at a time. For example, your doctor might ask you to make some changes in your diet and regular habits first. If the changes do not help, you might start taking medicine. If that does not work, you might need surgery.
You might be able to help your GERD symptoms by making some simple changes. These can include:
- Avoiding spicy or fatty foods, or eating them less often.
- Taking antacids that you buy at the drugstore or grocery store.
- Losing weight.
- Smoking less, drinking less alcohol, or stopping completely.
- Sitting or standing up for a certain time after eating – Instead of lying down.
- Raising the head of your bed to help with nighttime symptoms.
You might need medicines regularly if your GERD does not get better with lifestyle changes. Antacids are medicines that make your stomach produce less acid. This can make the stomach juices less irritating. Many of these medications can be bought from a store without a prescription from your doctor.
Prescription drugs may be more effective than non-prescription drugs for healing an irritated esophagus and relieving symptoms. Talk with your primary care doctor about the best medicine options for you. You can also talk with your surgeon if you have one.
You might have surgery if lifestyle changes and medicines do not help or you do not want to keep taking medicines. Surgery is very effective in treating GERD.
The most common operation for GERD is called a fundoplication. Doctors have done this surgery through an open incision in the belly since the late 1950’s, and with a minimally-invasive approach using multiple small incisions since the 1990s. If you have a hiatal hernia, your surgeon fixes this first. Then they “wrap” the top part of the stomach around the lower end of the esophagus. This makes the LES valve stronger, just like wrapping extra material or tape around a tube. Making the LES valve stronger helps prevent stomach juices from flowing back into the esophagus.
There are different ways to do this operation. The most common way this surgery is performed is with small (5mm-10mm) instruments through small incisions. This laparoscopic, or minimally-invasive, approach is currently the standard of care. However, if it is unsafe to perform the surgery this way your surgeon may use an “open” approach which is done via one large incision, or cut, in the upper abdomen.
The LES/valve can also be strengthened with a specially designed magnetic ring that a surgeon places around the bottom of the esophagus.
What are the advantages of laparoscopic surgery?
Having laparoscopic surgery usually means:
- Less pain after surgery
- Less time in the hospital after surgery
- A faster return to work and other normal activities
- Smaller scars – You will have more than one (1) scar, but they will be small.
Is laparoscopic GERD surgery for you?
Talk to your primary care doctor or a gastroenterologist to learn if it is appropriate. A gastroenterologist is a medicine doctor who specializes in conditions that affect the digestive system, including GERD.
If GERD surgery could be for you, have a thorough evaluation by a surgeon who is qualified to do it. This evaluation may include a scope, swallow x-ray or other test to check how well your esophagus squeezes food. Talk to your doctor or a gastroenterologist to find the right surgeon.
What to Expect Before Laparoscopic GERD Surgery
You will need a full physical examination. You might need some additional tests to make sure you are healthy enough for surgery. For example, you might need an EKG to check your heart. The tests you need depend on your age and general health.
The surgeon who will do the operation will talk with you about its risks and benefits. Then you will sign a form saying you understand and agree to have surgery.
Your surgeon’s office will tell you what to do and avoid before surgery. The exact instructions depend on your surgeon, but here are some common things to do.
- Take a shower the night before surgery and/or the same morning. Your surgeon might ask you to use an antibiotic soap.
- You might need to stop taking certain medicines before surgery. These include blood thinners, supplements, and medicines that affect your immune system or blood pressure. Talk to your surgeon when you schedule your laparoscopic GERD surgery.
- Do not eat or drink after midnight the night before your surgery. In the morning, you may take medications your surgeon told you are OK. Take these with just a sip of water.
- Stop smoking 4 to 6 weeks before the operation to reduce the chance you develop an infection.
- You will need someone to drive you home. You might also need someone to stay with you at first. Ask your doctor or nurse how much help you might need.
What to Expect the Day of Surgery
You usually come to the hospital the morning of your operation. A nurse or other medical team member will put a small needle and tube (IV) in one of your veins usually in your arm, so the team can give you medicines during surgery.
You will have general anesthesia for the surgery so you are not awake and do not feel any discomfort. The operation might last several hours. After that, you go to the recovery room until you wake up completely. You will probably stay in the hospital at least one night, and you might need to stay longer.
How is Laparoscopic GERD Surgery Done?
After you are asleep, your surgeon makes several small incisions (cuts) in your belly. These are one-quarter to one-half inch long. Next, your surgery team places small tubes in each incision and puts small instruments through them. One of the instruments is a tiny video camera or “scope”. This shows the surgery area on a TV screen in the operating room, so your surgeon can see.
Your medical team puts some carbon dioxide gas inside your belly during the operation. This puffs up the belly so your surgeon can see and use the instruments better.
What if I Cannot Have Laparoscopic GERD Surgery?
A few people cannot have laparoscopic GERD surgery. Your surgeon might need to switch to open surgery, with one (1) large incision during your procedure. Some reasons for having toswitch to open surgery are:
- You are very overweight.
- You had surgery in this area before, and you have a lot of scar tissue.
- The surgeon cannot see very well inside your body through the laparoscope.
- You have bleeding problems during surgery.
- The stomach or esophagus needs repair that cannot be done laparoscopically
It is not a complication (problem) if your surgeon decides to switch to open surgery. They will switch if it is the safest option for you. Your surgeon might not know this until after the laparoscopy starts. They will use their best judgment about the safest surgery for you.
What to Expect After Laparoscopic GERD Surgery
Will I Have Pain?
Any pain you have after laparoscopic GERD surgery is generally mild, but you might need prescription pain medicines for a short time.
You can go back to light activities at home immediately after surgery. This can include walking and using stairs. Avoid heavy lifting and strenuous activities, such as lifting more than 10 lbs, pushing, pulling or straining.
You will probably be able to go back to normal activities in approximately 4 weeks. Your surgeon will tell you when you can do various activities.
Your Diet and Medicines
You will probably not need to take antacid or GERD medicines after surgery. You might need a liquid diet (no solid food) for a short time after surgery. Ask your surgeon if you will need to be on a special diet after your surgery.
When to see your doctor after surgery
You should see your surgeon within 2-4 weeks after your operation.
Are There Side Effects to This Operation?
Studies have shown that this operation almost always cures GERD, or that people feel much better afterward. A few people do not feel better, or their reflux comes back months or years later. Some people have a second surgery if needed.
You might have some difficulty swallowing for a short time after the operation, but this usually goes away in 1 to 3 months.
Your surgeon may suggest a special diet after surgery for the first few week
Long-lasting side effects are uncommon. Some people have difficulty belching or vomiting after the surgery, and some have stomach bloating. A few people need a procedure to stretch their esophagus later. Some patients experience increased flatulence for a short period of time after surgery.
What Complications Can Occur?
This operation is considered safe, but any operation can have complications (problems). These can include:
- A bad reaction to general anesthesia
- Injury to the esophagus, spleen, liver, stomach, or other organs
- Infection in the wound, in the belly, or in the bloodstream
Your surgeon will talk with you about this. They will also help you decide if the risks of having this operation are less than treating your GERD in other ways.
When to Call Your Doctor After Laparoscopic GERD Surgery
Be sure to call your physician or surgeon if you develop any of the following:
- Fever over 101 degrees F (39 C) that does not go down on its own or with non-prescription medicines.
- Belly swelling that gets worse
- Pain that does not get better when you take your pain medicines.
- Nausea or vomiting that does not get better with medications – Call your doctor if you cannot eat or drink.
- Breathing problems or a cough that does not get better breath
- Blood or pus coming from any of the small cuts in the surgery area – Or redness that spreads or gets worse.
Call your doctor’s office if you have any other questions about your recovery.
Brought to you by:SOCIETY OF AMERICAN GASTROINTESTINAL AND ENDOSCOPIC SURGEONS (SAGES)
11300 West Olympic Blvd., Suite 600
Los Angeles, CA 90064
- (310) 437-0544
- February 22, 2022