GERD is a problem where stomach acid splashes back up into the esophagus creating irritation and damage. Food and or liquids can also splash up, this is known as regurgitation. Most patients complain of a combination of heartburn and regurgitation.
Patients with GERD should try and exhaust conservative treatments before seeking surgery. Conservative treatments include avoiding triggering foods (spicy, greasy, fried, acidic foods), eating dinner early in the evening, eating smaller meals, and sleeping with the head of your bed elevated. Most patients who decide on anti-reflux surgery also have symptoms despite being on one or multiple GERD medications. When all the above has failed, or patients would like not to be on medication for life, surgery is an option. Surgery is also a way to prevent the development of precancerous changes in the esophagus known as Barrett’s Esophagus, which can occur from prolonged GERD.
Before any anti-reflux surgery, all of our patients undergo a workup to ensure the surgery they choose will fix their concerns. Patients start with a barium esophagram (a type of xray with oral contrast) to see the anatomy of the esophagus and stomach. They may then be sent for a Bravo Probe (placed endoscopically) to measure how much acid is present with reflux. Some patients also undergo Esophageal Manometry or Endoflip which measures the strength and function of the esophagus.
LINX is a magnetic sphincter augmentation device that is placed around the esophagus to prevent acid from splashing back up the esophagus. The LINX device is a magnetic, titanium beaded ring, about the size of a quarter, that acts as a lower esophageal sphincter. The magnets open and allow food and liquids to pass into the stomach while eating or drinking, then close when at rest. The LINX is placed in a robotic, minimally invasive approach, limiting pain and your hospital stay.
A Nissen Fundoplication is another option for patients who want relief from GERD. It involves wrapping the stomach around itself (360 degrees) to tighten the lower esophageal sphincter and prevent acid reflux. The fundus of the stomach is then sutured together to stay in place. Other types of fundoplications that are not a full 360 degrees are sometimes performed as well. These are known as Dor or Toupet fundoplications.
TIF is a type of fundoplication performed endoscopically, or through your esophagus. It does not require any incisions and is done as an outpatient procedure. TIF is only performed on select patients who do not have large hiatal hernias. The stomach is wrapped around the esophagus and held in place with fasteners placed with the endoscope.