Gastroesophageal reflux disease (GERD) is a common digestive disorder in which stomach contents regurgitate (reflux) into the esophagus. GERD often causes inflammation and damage to the esophagus and occasionally to the lungs and vocal cords. Afflicting an estimated 25 million Americans, GERD has a variety of causes. Most patients respond well to non-surgical measures including dietary modification, weight loss and antacid therapy; however, lasting control of symptoms is sometimes difficult to attain.
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Surgical Treatment of GERD
For those patients in whom a medical regimen has not been successful in treating GERD, anti-reflux surgery can offer gratifying, durable results. While GERD can have several causes, surgery is most effective for those patients whose GERD is caused by a defective lower esophageal sphincter (LES), the muscle connecting the esophagus with the stomach. More than 90% of patients who undergo surgery have no reflux afterward. Surgery for GERD is performed by a laparoscopic procedure, and treats the reflux by making a new valve mechanism at the lower esophagus as a barrier to reflux. Minimally invasive procedures enable the patient to return home the same day and return normal activity.
Called fundoplication, the surgery involves constructing a new "valve" between the esophagus and the stomach by wrapping the upper portion of the stomach (the fundus) around the lowest part of the esophagus. As the stomach becomes distended during a meal, the wrap compresses the lower esophagus, preventing reflux. Fundoplication may involve repair of a hiatal hernia, if present. For patients who have other problems contributing to or accompanying their GERD, such as a swallowing disorder, a shortened esophagus, or gastric outlet obstruction, there are variations to this surgery.