| Esophagogastric Fundoplasty (for Reflux Disease) |
Many people are bothered by occasional heartburn. Sometimes, however, heartburn becomes more persistent and severe; a "sour"- tasting fluid comes up into the throat; and swallowing becomes more difficult. These symptoms are often indicators of gastroesophageal reflux disease, also referred to as GERD or reflux disease.
Reflux disease develops when a weakened valve-the lower esophageal sphincter-permits partially digested food and stomach acid to travel up the esophagus. A number of factors can contribute to reflux, including overeating, alcohol, smoking, pregnancy, and even the natural process of aging. Hiatal hernia, an opening in the diaphragm that enables part of the stomach to enter the chest area, may also contribute to a weakened lower esophageal sphincter.
Some people may be reluctant to ask a doctor about something as seemingly minor as heartburn. But left untreated, GERD can lead to narrowing of the esophagus or Barrett's syndrome, a change in the esophageal lining that carries with it an increased risk of cancer.
Medical Treatment of Reflux Disease
Once a diagnosis of reflux disease is made, the doctor may recommend some lifestyle changes, such as weight loss, a low-fat diet, avoidance of overeating or eating before bedtime, and quitting smoking. Sometimes elevating the head of a bed on blocks can make sleep more comfortable; gravity may help keep the reflux at bay.
There are also medications that can be recommended or prescribed. Antacids can help relieve the burning symptoms; motility drugs can increase the forward motion and emptying of the stomach; and other drugs can protect the esophagus from damage caused by stomach acid.
Surgical Treatment of Reflux Disease
Many people with reflux disease manage well with lifestyle changes and medications. However, for patients who have had not had success with medications; through diagnostic tests, have been found to have narrowing of the esophagus; or have reflux-induced airway problems similar to asthma, surgical treatment may be recommended. Or, some people who wish to be medication free may be evaluated for surgery.
There are at least four "open" surgical procedures used to resolve reflux: the Belsey IV, Hill gastropexy, Toupet fundoplasty, and Nissen fundoplication. The choice of procedure depends upon the patient's individual situation. With Nissen fundoplication, a part of the stomach is wrapped around the esophagus to create a new valve; Toupet is an example of a partial fundoplication. These procedures, which are successful in more than 90 percent of the cases, involve large incisions and a lengthy hospital stay and recovery period.
These procedures have been adapted to minimally invasive surgery and are known collectively as laparoscopic esophagogastric fundoplasty. With laparoscopic or minimally invasive surgery, a thin, telescope-like instrument attached to a camera is inserted into the body and produces magnified images on a television monitor. The surgeon watches the monitor and uses specially designed surgical instruments to perform the procedure. Instead of a large incision, there are four or five 1/4 inch to 1 inch incisions made for insertion of the camera and the instruments. Additionally, patients who undergo laparoscopic esophagogastric fundoplasty are discharged earlier from the hospital (1 to 2 days, as compared with 5 to 7 days with the open technique) and return to their normal routine quickly (7 to 14 days as compared with 4 to 6 weeks).
Laparoscopic esophagogastric fundoplasty is becoming the common method for surgical treatment of reflux disease. An estimated 66 percent of all surgical treatments for GERD were done laparoscopically in 1997; that number could be as high as 95 percent by 2005, according to one estimate. However, the choice of surgical technique is an individual matter to be discussed between patient and surgeon.