The Role of Surgery in GORD

Gastro-Oesophageal Reflux Disorder●Present in around 10% of the population ●Symptoms or damage to the mucosal lining of the

distal oesophagus●Caused by the contents of the stomach spending

a period of time in the distal oesophagus●Symptoms are not related to the severity of the

damage●Usually a chronic condition with relapses

What is GORD?

Menezes, N (2007), Surgeons Net

Generally requires long term management Symptoms relieved in less than 20% of patients without

medication 80% need it for relief

Antacids to control episodes of heartburn

PPI’s such as Omeprazole to control gastric acid

In severe cases surgery is an option Oesophagitis Barrett's Oesophagus

Management of GORD

Menezes, N (2007), Surgeons Net

Effective treatment of severe cases of GORD 91% Success rate needs good selection of patients

Those with a poor response to medical treatment Patient choice Barrett’s Oesophagus

Persisting Volume reflux

Regurgitation of gastric contents

Difficult benign strictures

Indications for Surgery

Menezes, N (2007), Surgeons Net

Involves surgically improving the viability of the lower oesophageal sphincter

Nissen Fundoplication

Toupet Fundoplication

Surgical Management of GORD

http://simple-med.blogspot.co.uk/2011_05_01_archive.html

http://www.youtube.com/watch?feature=player_detailpage&v=hRIDVQgv5Ek#

Nissen Fundoplication

Toupet Fundoplication

Canon C L et al. Radiographics 2005;25:1485-1499©2005 by Radiological Society of North America

http://radiographics.rsna.org/content/25/6/1485/F20.expansion.html

Endoluminal gastroplication● Uses an endoscope to fold the oesophagus and stitch in

place to reduce diameter at the gastro-oesophegeal junction

Endoscopic injection of bulking agents● Endoscope used to inject a bio-compatible polymer

substance around the gastro-oesophageal junction.

Other Surgical Techniques

http://guidance.nice.org.uk/IPG404http://guidance.nice.org.uk/IPG55

Removes the need for long term medication

Laparoscopic procedures the norm◦ Reduce scars, recovery time etc

Side effects◦ Dysphagia, belching, bloating and flatulence

Oesophageal motility disorders have the possibility to worsen outcomes◦ Achalasia

Surgical Outcomes

Menezes, N (2007), Surgeons Net

Both medical and surgical methods

Both effective – around 90%

Cost effectiveness●Equals out after 3 years vs medical treatments

Improvement can be increased though losing weight, stopping smoking and reducing alcohol intake

Summary

Web Reference 1: http://www.surgeons.org.uk/general-surgery-tutorials/gastro-oesophageal-reflux-disease-gord.html● Menezes, N (2007), Surgeons Net● Also contains list of papers for further reading

Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults (2010:3) Wileman SM, McCann S, Grant AM, Krukowski ZH, Bruce J, Cochrane Database of Systematic Reviews, John Wiley & Sons/ The Cochrane Library

References/Further Reading