GERD/Reflux & Swallowing
Gastroesophageal reflux disease, or GERD, is felt when stomach acid travels upward into the esophagus causing a mild to severe burning sensation. GERD symptoms range from mild to severe and can be infrequent or a daily occurrence, and leaving GERD untreated can result in tissue damage and put sufferers at risk for infection, ulcerations and cancer.
There are many reasons to surgically correct GERD symptoms. Gastroesophageal reflex patients after surgery often report one or more of the following:
- a reduction in severe heartburn impacting their daily lives,
- relying on fewer (or no) medications,
- having better sleep due to fewer (or no) reflux attacks while resting,
- regaining or expanding their food choices, and
- an improvement of quality of life by removing the pain and discomfort of GERD.
What types of GERD surgery are available?
Our board-certified surgeons can help patients suffering with GERD by performing a magnetic sphincter augmentation. A magnetic sphincter augmentation device is installed around the esophageal sphincter without changing it anatomically. The device is a magnetic ring that works to support the esophageal barrier to prevent acid from escaping the stomach in to the esophagus. The technology of the ring allows for patients to swallow, belch and be ill.
Using a laparoscopic procedure provides a minimally-invasive experience. The surgery is performed under general anesthesia and is typically completed in an hour or two. Patients will require only a short hospital stay. A small percentage of patients report having difficulty swallowing after the device is implanted and this can be part of the healing process. This feeling should fade over time. There can be an adjustment period or, if necessary, the surgery is reversible.
Patients can start to notice a difference in their GERD symptoms during the healing period. This type of surgery has reported long-term success for a significant number of patients.
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Laparoscopic Hiatal Hernia Repair
One cause for GERD can be a hiatal hernia. There is a naturally occurring gap where the esophagus and vagus nerve pass through the diaphragm. Sometimes a portion of the lower esophagus and/or stomach can squeeze through this gap, which is called a hiatal hernia. Symptoms of a hiatal hernia may include:
- regurgitation of food or liquids up the esophagus,
- acid reflux escaping past the esophageal sphincter,
- difficulty swallowing,
- chest pain,
- shortness of breath,
- and more.
Repairing a hiatal hernia may require surgery. A surgeon will help determine if an open surgery, fundoplication or a laparoscopic hernia repair is the best option. Many opt to perform the repair laparoscopically, the most minimally-invasive option to give patients a shorter healing period and very little scarring. The laparoscopic hiatal hernia surgery is performed under general anesthesia. The surgeon will make a series of small incisions in order to insert a tiny camera and surgical tools. The surgery will take several hours and an overnight hospital stay is required.
After the healing period, the hiatus pressure is relieved and GERD symptoms should be reduced or eliminated.
Laparoscopic Paraesophageal Hiatal Hernia
Our skilled esophageal surgeons may discover that a patient’s hiatal hernia is a paraesophageal hernia. This means that a large portion of the stomach is sitting in the chest cavity rather than below the diaphragm in the abdomen cavity. Often this type of hernia is asymptomatic. When patients begin to feel hernia symptoms, they should consider surgery. Common symptoms of a paraesophageal hernia include:
- Chest pain,
- Pain in the middle and/or upper abdomen,
- Difficulty swallowing,
- Shortness of breath, and/or
- Stomach ulcers.
Due to the evolution of advancements in laparoscopic surgery, many paraesophageal hernia patients are good candidates for this type of minimally-invasive procedure. Similar to the experience above, this surgery is performed under general anesthesia. The surgeon’s goal is to reduce the hernia sac, return the stomach to its anatomic position, and repair the gap that the hernia sac had squeezed through. There are many ways to repair the gap and a surgeon can detail the care plan during the surgical consultation.
To correct an ill-performing esophageal sphincter and reduce GERD symptoms, surgeons can perform a fundoplication. This procedure reinforces the esophageal sphincter by wrapping and suturing the stomach around the lowest part of the esophagus and the lower esophageal sphincter. Laparoscopic fundoplication surgeries are minimally-invasive. A fundoplication can be performed for patients who no longer want to rely on medicine to treat their GERD, for whom medicines are no longer effective, or who may not be able to take medication to reduce their GERD symptoms. A fundoplication may also be performed during other GERD-related or esophageal surgeries, such as hiatal hernia repairs, as a method to prevent the stomach from herniating back into the chest cavity.
Laparoscopic Roux-en-Y Gastric Bypass
Obesity can be a cause for GERD and related-issues, like hiatal hernias. Studies have shown that increased body mass index and excess eating can put stress on the gastroesophageal junction. Certain bariatric surgeries are able to correct GERD as a tool for weight loss. The Roux-en-Y gastric bypass procedure is more successful at reducing GERD symptoms compared to the gastric band or the gastric sleeve.
The Roux-en-Y gastric bypass removes a large portion of the stomach, where acids are produced and reduces the amount of food that can be consumed. This reduction of consumption can reduce the stress on the esophageal sphincter and/or reactions caused by certain foods or liquids that could lead to GERD symptoms.
At Bay Surgical Specialists, when a patient chooses a gastric bypass, they will go through our holistic program to determine if they are a good candidate. Our surgical team, a nutritionist, a fitness consultant and a clinical psychologist will meet with the patient to work through the weight loss journey before and after surgery. When it is time for surgery, the patient will be given general anesthesia and the surgeon will make a series of small incisions for medical tools and the laparoscopic camera. The surgeon will inspect the stomach. They will use a surgical stapler to divide the stomach into a small pouch section which will hold a few ounces of food. Then they will make an incision into the jejunum and connect the jejunum to the stomach pouch. A large portion of the stomach, the entire duodenum and a portion of the jejunum will be bypassed to give less surface area for calorie and nutrition absorption. The surgeon will need only a few stitches to close the incisions. This type of surgery takes less than four hours and recovery in the hospital is slightly longer than the gastric sleeve. After the procedure patients will be monitored by our medical staff, nutritionist, fitness consultant and have the option to participate in a therapeutic support group.
Bariatric surgery is a body-altering decision and patients face risks similar to other surgeries that involve general anesthesia. Our medical staff can review those risks.
Laparoscopic Heller Myotomy
Achalasia is a disorder of the esophagus, where the esophagus does not properly move food down to the stomach and/or the esophageal sphincter does not function properly to allow food to pass. Overtime, achalasia can worsen. A laparoscopic Heller Myotomy procedure can correct achalasia. While treating achalasia, our esophageal surgeon will likely perform two procedures. First they’ll perform a Heller Myotomy, where muscles are surgically altered to allow for better esophageal function, and second, a fundoplication to support the lower esophagus to prevent reflux from the stomach into the esophagus.
Achalasia patients will undergo a swallow study to determine the ability of the esophagus to move food and for the lower esophageal sphincter to relax to allow food to pass. A surgical care plan can determine if an open or laparoscopic surgery is the best course. The minimally-invasive route of a laparoscopic procedure is often the preferred option. Either option will involve the patient undergoing general anesthesia and require an overnight hospital stay. Our team can explain the benefits, risks and care plan for the Heller Myotomy during the surgical consultation.