What is Anti-Reflux Surgery?

Anti-reflux surgery is a procedure performed to treat gastroesophageal reflux disease (GERD), a condition in which a person's stomach acid and food travels back up the esophagus. This reflux occurs when the muscles connecting the esophagus to the stomach are too weak to close properly. It may also be worsened by the presence of a hiatal hernia, which occurs when the stomach protrudes through the opening of the diaphragm. This surgery can fix both of these problems to alleviate GERD symptoms. It may be performed in an open surgery or a laparoscopic surgery, which uses smaller incisions.

Patients should carefully discuss this surgery with their doctors to determine if this is the best option for them. Candidates for anti-reflux surgery may prefer a long-term solution to their symptoms that does not involve daily medications. They often have related complications, such as chronic cough and aspiration pneumonia, which is a type of lung infection. Other qualifying complications can include a narrowing of the esophagus, and bleeding or the presence of ulcers in the esophagus. Some patients may even experience a para-esophageal hernia, which can occur when the stomach twists out of position or becomes stuck in the chest.

Before undergoing anti-reflux surgery, patients will have a battery of tests performed to ensure safety. The doctor will typically order blood tests to check for liver and immune system function, as well as a pH test, to check the level of stomach acid in the esophagus. An upper endoscopy is a diagnostic procedure in which the physician inserts a tiny camera into the stomach through the esophagus to check the extent of the damage and to look for abnormalities. People will also need to disclose any other medical conditions they have, such as whether they may be pregnant or if they smoke. Medications and supplements will also be disclosed, such as blood thinners, aspirin and vitamin E, as well as diet drugs, anti-inflammatory medications, and St. John's wort.

The surgeon will likely instruct the patient to consume only clear liquids for one or more days before the anti-reflux surgery. This is necessary to completely empty the digestive tract. On the day of the surgery, patients will be placed under general anesthesia to render them unconscious. With an open surgery, a large incision will be made in the abdomen. A laparoscopic surgery requires three to five smaller incisions, through which tiny instruments are inserted.

During the surgery, the doctor will tighten the diaphragm's opening and repair the hernia. The upper portion of the stomach is then manipulated with stitches in a way that places pressure on the esophagus. Sometimes, a specific type of anti-reflux surgery, called endoluminal fundoplication, is used. In this procedure, instruments are inserted through the mouth. Rather than stitches, the surgeon places clips on the lower end of the esophagus.

Patients can typically expect to spend two to six days in the hospital if they have had an open surgery, or about one to three days for a laparoscopic anti-reflux surgery. Once they are released, recovery time can vary, but will generally last two to six weeks. Patients must be aware of the potential risks of anti-reflux surgery, including reactions to the anesthesia, infection, and difficult gas and bloating. Some people may experience temporary dysphagia, which is pain and other problems swallowing. Rarely, the hernia may return or the digestive tract may be damaged during surgery.