Surgery to Treat Reflux

by Dr. Christopher Chang, last modified on 1/8/12
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Reflux at its simplest definition is when stomach contents regurgitate up towards the mouth. If the reflux reaches the throat level, it can cause a multitude of symptoms that a patient may not necessarily consider to be associated with reflux. More often, a patient may erroneously assume their throat symptoms are due to infection or post-nasal drainage.

Reflux that reaches the throat area or higher is known as laryngopharyngeal reflux or LPR.

Assuming all medical interventions have been tried and failed and workup confirms the presence of laryngopharyngeal reflux, surgery may be required to resolve a patient's persistent throat problems.

Reflux Surgery

The surgery, regardless of the approach, attempts to tighten the valve between the stomach and esophagus. This tightening or fundoplication procedure is accomplished by a maneuver known as a stomach wrap which is analogous to cinching a belt to make an opening smaller (image modified from Wikipedia).

There are 3 different flavors of reflux surgery.

• Open approach where one long incision is created over the belly... this approach is hardly ever performed anymore and will not be discussed further.
• Laparoscopic Nissen Fundoplication: This approach uses tiny cameras and instruments inserted through multiple small incisions over the belly
• Trans-Oral Incisionless Fundoplication: This approach uses NO incisions over the belly. Rather, all instruments are introduced through the mouth and directed towards where the valve is located

Laparoscopic Nissen Fundoplication

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Trans-Oral Incisionless Fundoplication

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Most general surgeons know how to perform a standard laparoscopic nissen fundoplication. However, only a few are familiar with how to perform the incisionless method.

At least in the Northern Virginia region, Dr. Kevin Gillian is perhaps the most talented in the incisionless approach.

Workup Prior to Surgery

A patient must try non-surgical medical interventions first including:

If these conserative measures do not adequately address LPR, there are medications one can take. Such medications include proton pump inhibitors like Prilosec or Prevacid (which are over-the-counter) as well as nexium, protonix, etc as well as H2-blockers like zantac, pepcid, axid, etc. Be aware that these medications typically only work for acid reflux. If you are suffering from non-acidic reflux, surgery usually is required.

At a certain point, tests may be obtained to further evaluate a patient's reflux and is required prior to surgical consideration.

• Barium Swallow
• EGD
• 24 hour multichannel pH and impedance testing
• Manometry

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Watch Video of How a 24 hour pH and Impedance Testing is Performed

Medications to Treat Reflux sold on Amazon.com: