Nearly everyone reading this article has either undergone surgery or knows someone who has. Those who have experienced surgery are probably in no hurry to go through it again; despite its obvious benefits, entering a hospital for an operation is hardly a fun experience. While most people associate surgery with clearing blocked arteries or reconstructing damaged bones and tissues, surgical procedures are also used to address patients suffering from GERD.
Gastroesophageal reflux disease, thankfully abbreviated as GERD, is estimated to impact roughly 20 percent of Americans to at least some degree. This common and thoroughly unpleasant condition occurs when the contents of the stomach back up into the esophagus (we told you it was unpleasant!). As with other conditions, the severity of GERD can vary on a case-by-case basis. Most patients usually experience some combination of these following symptoms:
- Hoarse throat
- A frequent and unexplained dry cough, which occurs mostly at night
- The mouth’s production of saliva suddenly spikes
- Bad breath
- Ear aches
It should be noted that many asthmatics also suffer from GERD. Consequentially, the appearance of GERD symptoms can subsequently trigger asthma-related problems. GERD can also cause chest pains that mimic a heart attack (as a precaution, people who experience chest pains should seek medical attention immediately).
As bothersome as GERD can be, it can usually be addressed without a surgeon’s knife. Depending on the patient’s condition, a doctor will typically advise either over-the-counter drugs or prescription-strength medications. In many cases, these first and second-line medications are enough to control and mitigate GERD symptoms.
As many Americans are aware of, however, GERD can be a very challenging opponent to vanquish. If neither non-prescription nor prescription medicines prove to be effective, the patient might be asked to consider surgical options. Doctors may also resort to surgery in the patient’s esophagus has suffered a massive amount of inflammation, a condition medically referred to as esophagitis. Other circumstances that may necessitate surgery include a non-cancerous narrowing of the esophagus and Barrett’s esophagus, a condition in which tissues in the esophagus take on the form of intestinal tissues.
Though GERD surgery is not especially common, it is certainly not unheard of. An estimated 23,000 patients with GERD undergo surgery for their symptoms each year.
Prior to getting surgery for GERD, most patients are first scheduled for an endoscopy, which is used to determine if surgery is truly needed. During an endoscopy, a device appropriately known as an endoscope is inserted into the patient through either the mouth or rectum. An endoscope is simply a long tube with a tiny camera positioned on one end. Once inside the body, this camera transmits data back to the doctor via a TV or computer monitor.
Aside from an endoscopy, a patient may also be asked to undergo an esophageal manometry. An esophageal manometry is used to determine if the esophagus is properly channeling food into the stomach. This test is administered using a catheter; like an endoscope, a catheter is a long flexible tube that is inserted directly into the patient. Instead of a camera, however, an esophageal catheter transports a sensor into the esophagus (some catheters are built with two sensors).
The most common surgery used to address GERD problems is known as a fundoplication. This procedure begins with the surgeon making a surgical cut (known as an incision) in the patient’s abdomen. Surgeons usually perform fundoplications using minimally invasive techniques, cutting a relatively small portion of tissue. Such procedures are known as laparoscopic surgeries. After making the incision, the surgeon then inserts a camera into the body. This camera provides the surgeon with a clear look inside the patient’s body, allowing the surgeon to operate safely.
Alternatively, the surgeon may opt to make a much larger incision into the abdomen, an approach known as a laparotomic surgery. Unlike a laparoscopy, a laparotomic surgery does not involve the use of a camera. Instead, this procedure allows the surgeon a get a first hand-look into the afflicted area.
Regardless of which method the surgeon employs, a fundoplication typically calls for the upper part of the patient’s stomach to be wrapped around the bottom section of the esophagus. The surgeon then sews together the overlapping sections of the stomach and esophagus. While this might understandably sound quite unnerving, this procedure significantly tightens the lower end of the esophagus. In turn, the esophagus is much better equipped to hold back the stomach’s onslaught, keeping foods and beverages safely stored inside the stomach organ.
Unlike other types of surgery, which can involve several months of grueling rehabilitation, patients are generally able to recover from a fundoplication procedure fairly quickly. For laparoscopic fundoplications, a patient is usually hospitalized for only two to three days, and can resume a normal lifestyle and diet in about two to three weeks. Given the small size of laparoscopic incisions, relatively few people who undergo this procedure are left with permanent scars.
The recovery timetable for laparotomic surgery is somewhat different. Since this procedure involves a larger incision, the patient usually needs more time to fully heal. In most cases, the body is able to bounce back from a laparotomic fundoplication after four to six weeks. Unfortunately, laparotomies often leave unsightly scars on the patient’s abdomen. With a longer recovery period and significant cosmetic damage, doctors tend to eschew laparotomic surgeries in favor of the less invasive laparoscopic option.
Outcomes and Side Effects
Thanks to decades of medical advances, surgical procedures are usually successful in achieving their goals. This statement certainly applies to fundoplications; approximately 80 percent of GERD patients experience improved digestive health following surgery. Furthermore, research has found that surgery reverses esophageal tissue damage in 9 out of 10 patients.
Of course, surgery of any type is not without risk. Forty percent of patients who have a fundoplication experience a resurgence of symptoms, a return bout of esophagitis, need an additional operation or are forced to take medications for GERD symptoms. Common side effects include difficulty swallowing, increased flatulence and an inability to belch.
GERD afflicts millions of Americans, and can make life much more difficult for those who develop it. Though surgery is not often associated with GERD, it can be necessary tool for fixing a broken digestive tract.