How is surgery performed for gastroesophageal reflux?

Surgery for gastroesophageal reflux strengthens the barrier between the stomach and the esophagus. Fundoplication is one of the main techniques used and is generally performed using minimally invasive surgery.

How does reflux surgery work?

Reflux surgery can be performed through fundoplication. In this technique, the upper part of the stomach, called the gastric fundus, is positioned around the lower portion of the esophagus. The goal is to strengthen the barrier that prevents stomach contents from returning to the esophagus.

Fundoplication can be complete or partial. In complete fundoplication, the fundus of the stomach wraps around the entire circumference of the lower portion of the esophagus. In partial fundoplication, the fundus of the stomach wraps around only part of the circumference of the esophagus.

The choice between complete and partial fundoplication considers the examinations performed before surgery and the characteristics of each patient. Reflux control and the risk of swallowing difficulties are also considered when choosing the technique.

Is a hiatal hernia also repaired during surgery?

When a hiatal hernia is associated with reflux, hernia repair may be part of the surgery. A hiatal hernia occurs when part of the stomach passes through the diaphragm into the chest.

During hiatal hernia repair, the stomach is repositioned in the abdomen, and the opening in the diaphragm may be repaired. This opening is called the esophageal hiatus and allows the esophagus to pass through to the stomach.

Surgical planning depends on the size and characteristics of the hernia, as well as the anatomy of each patient.

Is reflux surgery performed laparoscopically?

Reflux surgery can be performed laparoscopically or robotically. Both laparoscopy and robotic surgery use small incisions in the abdomen to access the operated area.

The Society of American Gastrointestinal and Endoscopic Surgeons considers laparoscopic and robotic approaches as options for selected adults undergoing surgical treatment for reflux.

Before surgery, evaluation may include upper gastrointestinal endoscopy, esophageal manometry, and reflux monitoring by pH-metry. Manometry assesses the movements and pressures of the esophagus. pH-metry measures the esophagus’s exposure to acid over the monitoring period.

Endoscopy, manometry, and pH-metry provide important information to confirm the diagnosis and plan treatment.

What can happen after fundoplication?

Difficulty swallowing, called dysphagia, can occur after fundoplication. Dysphagia may be transient during recovery, but its progression should be monitored.

Abdominal distension and difficulty burping can also occur after fundoplication. The combination of abdominal distension and difficulty expelling gas orally is known as gas-bloat syndrome.

Diet is usually adapted during recovery to facilitate food passage while the operated area heals. Diet progression depends on each patient’s recovery and the guidance of the responsible team.

Can everyone with reflux undergo surgery?

Anti-reflux surgery is indicated for selected patients after diagnosis confirmation and appropriate evaluation.

Surgery may be considered for individuals with confirmed gastroesophageal reflux disease who have an indication for surgical treatment. The presence of a hiatal hernia, symptoms, response to clinical treatment, and esophageal function assist in the decision.

Heartburn and regurgitation can also occur in other digestive conditions. Therefore, confirming reflux disease before surgery is important to appropriately select the treatment.