Surgical Treatments

What is anti-reflux surgery?

With surgery for GERD, the goal is to recreate the mechanism of the lower esophageal sphincter.

The most common surgical method for doing so, is to perform a fundoplication (gastroesophageal ‘wrap’). During fundoplication, the top part of the stomach is gently mobilized and used to create a wrap around the lower part of the esophagus. This wrap will have similar functionality as the lower esophageal sphincter, in terms of keeping acid and bile into the stomach and away from the esophagus.

There are several types of fundoplication procedures (total, partial anterior, partial posterior, etc). The approach to fundoplication type selection is individualized based on each patient's characteristics. All of these procedures are typically performed with minimally invasive surgery options, allowing for a brief hospital stay and a quick recovery. 
 

What is a hiatal hernia repair?
Often, patients with GERD are found to have a hiatal hernia. This means that a portion of one’s stomach (the acid producing organ) has slipped into the chest cavity through the diaphragm (breathing muscle). Hiatal hernias contribute to GERD and they can even be responsible for symptoms that do not respond to medications. In addition, some hiatal hernias can cause a patient to experience difficulty swallowing, trouble breathing, anemia, abdominal or chest pains. These symptoms can be present even without traditional GERD. Importantly, there is a risk of larger hiatal hernias causing the stomach to twist (‘volvulus’).

During a hiatal hernia repair, the stomach is brought out of the chest and positioned below the diaphragm. The diaphragm opening, that allowed for the hernia, is then approximated with sutures. Typically, a fundoplication procedure is also performed at the same time (see above section). Most hiatal hernia repairs are completed using minimally invasive surgery (small incisions).