What if the pain and discomfort of acid reflux just becomes too much, or the thought of being on PPI’s for the rest of your life just sucks? Well, there’s always surgery.
Surgical procedures for acid reflux include endoscopic procedures such as the Esophyx and the EndoCinch systems, endoscopic augmentation with hydrogel implants, radio frequency treatment, fundiplication, and the Linx procedure.
Read on below…
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Personally I think it must be the last resort because it is so invasive, even though there are ways of minimizing the surgery by, for example, laparoscopic procedures (see below). The main reasons you might need to consider surgery are:
- Constant pain and discomfort which non-surgical methods can’t resolve.
- A “stricture” (narrowing) of the esophagus.
- Esophagitis ie severe inflammation of the esophagus.
- Barrett’s esophagus, which is where the cells of the esophageal lining are changed by the acid reflux.
An academic paper from 2009 (by Broeders et al) showed 92% of people had resolution of their reflux symptoms via surgery. The study demonstrated in trials that candidates who are likely to get benefit from surgery include:
- People with confirmed acid reflux which respond well to PPI therapy
- Confirmed pathological reflux on 24 hour pH testing
- Hiatus hernia and/or oesophagitis
- Patients with Barrett’s oesophagus and on-going reflux symptoms
Weaker indications for surgery include
- Sore throat or burning in the throat in people with confirmed acid reflux
- Cough with confirmed acid reflux
- Hoarse voice with confirmed acid reflux
In these last categories, only 7 out of 10 people are thought to respond.
Before anyone is accepted for surgery, a number of tests will be performed, to check the functioning of the lower esophageal sphincter (the LES), and the condition of the esophagus itself. This will probably involve an endoscopy (a small probe with a light and camera placed down the throat) and an acidity test.
So, here’s how to get rid of acid reflux thru surgery. The choice at present seems to be:
- Endoscopic Procedures: Using an endoscope with tools at its tip, surgeons perform either the Esophyx system, where the the end of the esophagus is tightly bound to the top of the stomach, or the EndoCinch system, where stitches are placed in the lower esophagus to form pleats that strengthen the area. These are minimally invasive procedures, and often require no, or little anesthesia, and have a relatively quick recovery time.
- Endoscopic injection of bulking agents: This is where a combination of plastic and liquid is injected into the junction between the stomach and the esophagus (The gastro-esophageal junction). This narrows the junction and helps to prevent acid leaking up from the stomach. There is little known about the long term effectiveness and safety of this procedure, and side effects can include:
- chest pain
- feeling sick
- high temperature of 38ºC (100.4ºF) or above
- Endoscopic augmentation with hydrogel implants : The surgeon uses hydrogel to narrow your gastro-esophageal junction. Hydrogel is a type of flexible plastic gel very similar to living tissue. The most common complication arising from this procedure is that the hydrogel starts to come out of the gastro-esophageal junction. One study found this happened in one in five cases. However, this is a relatively new technique and success rates may well improve in future.
- Radiofrequency treatment: This is also known as the Stretta procedure. Again using an endoscope, high-energy waves are directed into the wall of the lower esophagus. The esophagus responds by producing small amounts of scar tissue. In most people, this reduces heartburn and other acid reflux symptoms, though there appears to be relatively little known about the long term effectiveness and safety of this procedure. Possible complications and side effects may include:
- chest pain
- injury to the oesophagus
- Nissen Fundoplication: This involves wrapping the upper part of the stomach around the lower part of the esophagus, thereby tightening the LES, and preventing the acid from refluxing. Open surgery, as the name suggests, means the operation is carried out with the esophagus and stomach exposed; with laparoscopy (also known as Laparoscopic Nissen Fundoplication), the surgeon operates by cutting small slits in the skin through which instruments and a camera are inserted. The benefits of the latter procedure are that there is less scarring, and the patient recovers more quickly.
- According to WebMD, Five or more years after fundoplication for acid reflux, 90% to 95% of people surveyed report feeling satisfied with their surgery and its results. More than 80% of people describe relief of their symptoms as good or excellent. Common side effects of fundoplication include:
- dysphagia (difficulty swallowing)
Here’s a video by a surgeon explaining how the procedure is done:
These side effects should resolve over the course of a few months. However, in about 1 in 100 cases they can be persistent. In such circumstances, further corrective surgery may be required.
Here is a video of a patient who went through the operation answering common questions about life after the procedure:
- The Linx procedure: Linx is a tiny necklace of beaded magnets that is surgically placed around the esophagus. It expands to let food down into the stomach, but the magnets hold the acid in the stomach. A clinical trial, published in the New England Journal of Medicine in February 2013 showed that following LINX reflux Surgery, 92% of patients improved their quality of life and 93% reduced their use of PPIs. Read the full article In 2012 it was licensed by the US FDA and is now offered in various specialised centres, as it is in the UK. However, there is no data about its long term effectiveness, and it currently costs in the region of $14,000 (£9,000). Here’s a video explaining how it works:
And here’s a video from a patient, who had the device fitted. If you’re considering this, it is worth watching the whole video:
So, that’s how to get rid of acid reflux thru surgery. However, as always, I am not providing advice in this article and anyone contemplating surgery should obtain initial advice from a qualified (and, ideally, specialised) medical practitioner.
Sources for this article include NHS Choices http://www.nhs.uk/Conditions/Gastroesophageal-reflux-disease/Pages/Treatment.aspx, Linx for Life http://www.linxforlife.com/, WbMD http://www.webmd.com/heartburn-gerd/guide/treating-with-surgery?page=2,