Surgical Options For GERD
-
Upload
c-daniel-smith -
Category
Health & Medicine
-
view
4.956 -
download
0
Transcript of Surgical Options For GERD
Surgical Treatment of GERD
Which procedure is best for you?
C. Daniel Smith, MD
Nissen Fundoplication• Most common procedure performed
• Most often done laparoscopically
• Open approach may be recommended for redo surgery or complex hiatal hernia
• With an experienced surgeon, 90-95% of patients have good control of typical GERD symptoms
Endolumenal Procedures• Newer procedures performed through
the mouth and without any incisions in abdomen
• Esophyx TIF and Stretta are only ones currently available in U.S.
• Not an option in those with moderate to large hiatal hernia or Barretts esophagus
• With an experienced surgeon, 60-80% of patients have control of typical GERD symptoms
Linx Reflux System• Recently approved by FDA
• Implanted laparoscopically around end of esophagus
• Outpatient procedure
• Not an option in those with Barretts or more than 3 cm hiatal hernia
• Only available at select centers
Nissen Fundoplication
• Best studied and most common procedure performed
• Highest rate of success (90-95%)
• Hiatal hernia is fixed
• Best success with atypical GERD symptoms (80-90%)
• Most invasive procedure requiring incisions in abdomen
• Full recovery takes 3-4 weeks
• Failure requires more complex redo surgery
• Outcome dependent on surgeon skill and experience
Pros Cons
Endolumenal Procedures
• No incisions
• Less pain
• Faster recovery
• If fails, still candidate for laparoscopic Nissen
• New - unknown long term success
• Lower initial and early success rates (60-80%)
• Unknown results with atypical GERD symptoms
• Not many surgeons with experience
• Many insurance companies do not cover
Pros Cons
Linx Reflux System
• Mechanically very similar to native esophageal sphincter
• No need to alter diet after surgery
• Minimal side effects
• If fails, still candidate for laparoscopic Nissen
• New - unknown long term success
• Not an option in Barretts or more than 3 cm hiatal hernia
• After Linx implanted patient can not have an MRI
• Not widely available
Pros Cons
Nissen Fundoplication
• 60-90 minute procedure
• 1 night stay in hospital
• Risk of complication less than 1%
• No heavy lifting for 4 weeks after surgery
• Liquid/soft food diet for 4 weeks after surgery
• Most are able to return to work 2-4 weeks after surgery
• OK to shower the day after surgery
• OK to drive when no longer using prescription pain medicine
• No special help needed at home
Details
Endolumenal Procedures
• 45-60 minute procedure
• 1 night stay in hospital
• Risk of complication less than 1%
• No heavy lifting for 4 weeks after surgery
• Liquid/soft food diet for 2 weeks after surgery
• Most are able to return to work 1-2 weeks after surgery
• OK to shower the day after surgery
• OK to drive when no longer using prescription pain medicine
• No special help needed at home
Details
Linx Reflux System
• 30-45 minute procedure
• No overnight stay
• Less than 0.1% chance of complication
• Maintain regular diet immediately
• Most are able to return to work 1-2 weeks after surgery
• OK to shower the day after surgery
• OK to drive when no longer using prescription pain medicine
• No special help needed at home
Details
GERD Definitions
Typical GERD SymptomsHeartburnRegurgitationChest pain
Atypical GERD SymptomsCoughLaryngitisSore throatAsthma