Acid Reflux Surgery

• Heartburn, a burning sensation in the chest, usually after eating, which might be worse at night when lying down
• Chest pain
• Difficulty swallowing
• Regurgitation of food or sour liquid
• Sensation of a lump in the throat (globus)
• Strained voice
• Chronic cough
• Laryngitis
• New or worsening asthma
• Disrupted sleep

If lifestyle changes and medication do not help, or if there are complications like severe oesophagitis, Barrett’s oesophagus, or oesophageal stricture, surgery may be considered.

Lifestyle Changes and Medications:

• Avoiding foods and beverages that trigger reflux (eg: fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, caffeine)
• Eating smaller meals
• Not eating close to bedtime
• Elevating the head of the bed
• Quitting smoking
• Losing weight if overweight
• Antacids or H2 receptor blockers
• Proton pump inhibitors (PPIs), which reduce stomach acid production

Surgical & Interventional Procedures:

• Fundoplication: The standard surgical treatment for GORD is a procedure called fundoplication. The top of the stomach (the fundus) is wrapped around the lower oesophageal sphincter to tighten the muscle and prevent reflux. Fundoplication can be done laparoscopically, which is minimally invasive. Dr Kaushal performs the following fundoplication techniques:
  • Watson Fundoplication (180° wrap)
  • Partial Anterior “Dor” Fundoplication (200° wrap)
  • Partial Posterior “Toupet” Fundoplication (270° wrap)
  • Total “Nissen” Fundoplication (360° wrap)
  • +/- the use of biological mesh (eg: Phasix mesh) during cruroplasty to reinforce the strength of the repair
• LINX Device (not available in Australia yet): A ring of tiny magnetic beads is wrapped around the junction of the stomach and oesophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid but weak enough to allow food to pass through.
• Endoscopic Techniques: These involve procedures done through an endoscope (a long, flexible tube with a camera) and can include:
  • Radiofrequency Treatment (not available in Australia currently): Also known as Stretta procedure, radiofrequency energy is used to create small burns that help to tighten the LOS.
  • Endoscopic Sewing: A device called an endoscope is used to sew the LOS to increase its pressure.
• Transoral Incisionless Fundoplication (TIF) (not available in Australia yet): A newer procedure that improves the function of the LOS by creating a partial fundoplication with the aid of an endoscope inserted through the mouth.

After surgery for acid reflux, patients typically have a reduced ability to belch or vomit and may experience bloating or diarrhea. These symptoms often improve over time. Recovery from a laparoscopic procedure may be faster, with less pain and smaller scars compared to open surgery.

Patients need to follow a special diet that starts with liquids followed by gradual progression to solid foods. They must avoid strenuous activities for a certain period, as recommended by their surgeon.

As with all surgeries, there are associated risks, such as:

• Anaesthesia complications
• Infection
• Bleeding
• Scarring
• Difficulty swallowing due to the stomach being wrapped too tightly
• Recurrence of GORD symptoms over time
• Gas-bloat syndrome

Surgical treatment of GORD usually has good long-term results, with many patients remaining symptom-free for years after surgery. However, some may still need medication, or continue to make diet and lifestyle changes to remain symptom free.