Gastroesophageal Reflux Disease (GERD)

Fundoplication surgery may be used to treat gastroesophageal reflux disease (GERD) symptoms that have not been well controlled by medicines. In fundoplication surgery, the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place to strengthen the valve between the esophagus and stomach (lower esophageal sphincter).

Surgery may be an option when:

• Treatment with medicines does not completely relieve a person's symptoms, and the remaining symptoms are proved to be caused by reflux of stomach juices.
• A person does not want or, because of side effects, a person is unable to take medicines over an extended period of time to control his or her GERD symptoms and is willing to accept the risks of surgery.
• Along with reflux a person has symptoms such as asthma, hoarseness, or cough that do not adequately improve when treated with medicines.

Surgery Choices

Fundoplication surgery is the most common surgery used to treat GERD. This surgery strengthens the valve between the esophagus and stomach (lower esophageal sphincter) to keep acid from backing up into the esophagus as easily.

Other types of surgery for gastroesophageal reflux disease may include:

• Partial fundoplication. Partial fundoplication (Toupet procedure) involves wrapping the stomach only partway around the esophagus. Full fundoplication involves wrapping the stomach around the esophagus so that it completely encircles it. Most fundoplication surgery uses the full fundoplication method.
• Gastropexy. A gastropexy attaches the stomach to the diaphragm so that the stomach cannot move through the opening in the diaphragm into the chest. Gastropexy is done less often than fundoplication.

Some nonsurgical procedures are being tested that may be an alternative to surgery for GERD. These procedures are still undergoing trials to find out their long-term safety and effectiveness. These are nonsurgical treatments, so no cuts are made. Instead, these treatments are done through the mouth into the esophagus. An endoscope is placed in your mouth and down your throat into your esophagus. The endoscope is a long, thin, flexible tube. The doctor can see into your esophagus using this tube. The different kinds of nonsurgical treatments use endoscopes that can do different things. But all the procedures developed so far try to block stomach acid from backing up (or refluxing) into the esophagus.

Nonsurgical treatments being studied for GERD include:

• Sewing "pleats" (plication) in the area where the esophagus and stomach meet (the lower esophageal sphincter, or LES). These pleats strengthen the LES and help keep stomach acid out of the esophagus.
• Radiofrequency thermal treatments. These treatments use radiofrequency waves to heat the tissues of the LES. The heat damages the tissue and may affect the nerves that relax the LES. The scar tissue that forms may help strengthen the LES. It is also thought that if the nerves are damaged, the amount of acid backing up into the stomach is less.
• Injectable or implantable treatments. These involve injecting or implanting something (usually plastic) into the muscle in the esophagus. The injected substance acts as a bulking agent, making the LES smaller and making is less likely that stomach acid can back up into the esophagus.

What To Think About

Fundoplication surgery is successful in about 6 to 9 out of 10 cases.⁵ Successful surgery relieves GERD symptoms and inflammation of the esophagus (esophagitis). But fundoplication surgery is not always stable and effective over the long term, and people may have to continue to take some medicines after surgery.

Fundoplication surgery using a laparoscopic technique is done most often. In this method, a thin, lighted tube (laparoscope) is inserted into the abdominal cavity through a very small incision in the wall of the abdomen. The laparoscope allows the surgeon to see inside the abdomen without making a large incision. Surgical instruments can also be inserted through additional small incisions. Recovery time and hospital stays are both shorter with laparoscopic surgery than with open surgery, which requires a larger incision. When you are choosing a surgeon, the most important thing to consider is experience. Find out the number of these procedures the surgeon has performed and his or her success rate.

Should I use medications or surgery to treat gastroesophageal reflux disease (GERD)?

Before surgery, additional tests will usually be done to be certain surgery is likely to help relieve the person's GERD symptoms and to diagnose problems that surgery could make worse. For more information on this testing, see esophageal testing in the Exams and Tests section of this topic.