Surgical Options For GERD

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A brief outline of current options for the surgical management of gastroesophageal reflux including the pros and cons of each.

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  • Surgical Options For GERD

    1. 1. Surgical Treatment of GERD Which procedure is best for you? C. Daniel Smith, MD
    2. 2. 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
    3. 3. 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
    4. 4. 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
    5. 5. Nissen FundoplicationPros Cons• Best studied and most • Most invasive procedure common procedure requiring incisions in performed abdomen• Highest rate of success • Full recovery takes 3-4 weeks (90-95%) • Failure requires more• Hiatal hernia is fixed complex redo surgery • Outcome dependent on• Best success with surgeon skill and atypical GERD experience symptoms (80-90%)
    6. 6. Endolumenal ProceduresPros Cons• No incisions • New - unknown long term success• Less pain • Lower initial and early success rates (60-80%)• Faster recovery • Unknown results with atypical GERD symptoms• If fails, still candidate for • Not many surgeons with laparoscopic Nissen experience • Many insurance companies do not cover
    7. 7. Linx Reflux SystemPros Cons• Mechanically very similar • New - unknown long term to native esophageal success sphincter • Not an option in Barretts or more than 3 cm hiatal• No need to alter diet hernia after surgery • After Linx implanted patient can not have an MRI• Minimal side effects • Not widely available• If fails, still candidate for laparoscopic Nissen
    8. 8. Nissen FundoplicationDetails• 60-90 minute procedure • Most are able to return to work 2-4 weeks after• 1 night stay in hospital surgery • OK to shower the day after• Risk of complication less surgery than 1% • OK to drive when no longer• No heavy lifting for 4 using prescription pain weeks after surgery medicine • No special help needed at• Liquid/soft food diet for 4 home weeks after surgery
    9. 9. Endolumenal ProceduresDetails• 45-60 minute procedure • Most are able to return to work 1-2 weeks after surgery• 1 night stay in hospital • OK to shower the day after surgery• Risk of complication less than 1% • OK to drive when no longer using prescription pain• No heavy lifting for 4 medicine weeks after surgery • No special help needed at home• Liquid/soft food diet for 2 weeks after surgery
    10. 10. Linx Reflux SystemDetails• 30-45 minute procedure • Most are able to return to work 1-2 weeks after surgery• No overnight stay • OK to shower the day after surgery• Less than 0.1% chance of complication • OK to drive when no longer using prescription pain• Maintain regular diet medicine immediately • No special help needed at home
    11. 11. GERD Definitions Typical GERD Symptoms Heartburn Regurgitation Chest pain Atypical GERD Symptoms Cough Laryngitis Sore throat Asthma

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