Digestive Health

Treating GERD With Surgery: Learn Your Options

Oct 8, 2020

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If you’re among the 20 percent of the U.S. population suffering from gastroesophageal reflux disease (GERD), you may be searching for a permanent solution. The heartburn you experience when the gastric acid in your stomach flows back up into your esophagus (the tube from your throat to your stomach) is not only uncomfortable, it can become life-threatening. GERD sometimes leads to esophageal cancer, ulcers, chronic coughing, and potentially serious damage to your digestive tissue called Barrett’s esophagus.

When medication won’t eliminate your GERD symptoms, your doctor may recommend surgery. James E. de Caestecker, DO, FACS, describes two surgical approaches to treating GERD:

Nissen fundoplication
LINX implant

Both surgeries aim to strengthen or mimic the function of the lower esophageal sphincter (LES) valve, which prevents stomach acid from backing up into your esophagus.

Nissen Fundoplication

“In this procedure, which has been the benchmark surgery for treating GERD, we take the upper part of the stomach and wrap it all the way around the lower esophagus,” explains Dr. de Caestecker. “This puts pressure on the esophagus. As long as the pressure is higher than the resting pressure in your stomach, you’ll be less likely to experience reflux; the gastric acid in your stomach is less likely to flow back up into your esophagus.”

The surgery results are positive, Dr. de Caestecker reports. “About 85 to 95 percent of the time, patients get off their medications and have great reflux control,” he says. Common side effects of the surgery include:

Bloating
Abdominal distention
Excess gas
Difficulty swallowing
Inability to burp or vomit

Most often the procedure is laparoscopic (The surgeon inserts tiny tools after making several small cuts in your belly area.) In some instances, an open surgery may be preferred (surgeon makes a large incision in your upper belly). A liquid diet may be necessary for up to four weeks following the surgery. A return to normal activity usually occurs two to three weeks after laparoscopic surgery, and four to six weeks after open surgery. Due to temporary swelling in your esophagus, you may experience tightness when you swallow for up to eight weeks.

LINX Implant

A newer surgical option involves permanently implanting a bracelet of tiny magnetic beads (called a LINX) around your esophagus where it meets the stomach. The magnetic attraction between the beads holds the esophagus closed. When food slides through the esophagus it pushes the beads apart, allowing the food to pass into the stomach, but acid is prevented from backing up into the esophagus and causing heartburn.

“This procedure is sometimes called magnetic sphincter augmentation. It’s basically trying to recreate the normal lower esophageal sphincter,” Dr. de Caestecker explains.

“Because the LINX is a fairly new device, any long-term effects, like 10 to 20 years later, aren’t yet known,” he adds. “LINX is a foreign body being permanently implanted inside you, so you’d want to take that into consideration before moving forward with this surgery.” Studies have indicated that after several years, LINX is as effective as fundoplication. Difficulty swallowing is the most commonly reported complication. Unlike fundoplication, burping and vomiting are not a problem. “Sometimes after the procedure we’ll need to go back and stretch the esophagus if swallowing is too difficult,” says Dr. de Caestecker.

Following the procedure, you’ll be encouraged to return to a normal diet as soon as you are ready to do so. And you should be able to return to nonstrenuous activity within a couple of days. Because the LINX device is titanium, this may affect your ability to get an MRI in the future, but it should not affect your ability to go through airport security.

Before You Decide

Before surgery is considered as a treatment for GERD, Dr. de Caestecker believes it is important to first consider making lifestyle modifications instead. “Cutting back on alcohol, anything with caffeine including chocolate, and carbonated beverages may reduce reflux and eliminate the need for surgery.” Quitting smoking and losing weight also can significantly help. “Obesity is a big reason why people reflux,” he says. The weight puts pressure on the stomach and pushes gastric acids up. The acids put pressure on the LES and reflux occurs.

Why Surgery Is a Popular Choice

Reflux surgery is increasing in popularity, says Dr. de Caestecker, because people don’t like the side effects of the medications they are taking to treat GERD, and they don’t want to take the medications for the rest of their lives. “New research indicates some of the medications increase the risk of dementia, osteoporosis, and esophageal and gastric cancer,” he says.