GERD
Surgical Solutions.

What is GERD?

Gastro esophageal Reflux Disease—or GERD—is more than just heartburn. It’s a chronic, often progressive disease that interferes with how you digest food and often interrupts a good night’s sleep.

Common symptoms include heartburn, regurgitation, difficulty swallowing, and chest pains. It’s also associated with tooth decay, gingivitis, bad breath, ear aches, chronic cough, worsening asthma, recurrent pneumonia, abdominal bleeding, belching, chronic sore throat, hoarseness, throat clearing, laryngitis, lump in the throat, or post nasal drip.

Why Does It Matter?

GERD can affect your daily activities, your sleep, and your enjoyment of life. And untreated GERD can lead to more serious health conditions. It occurs when stomach acid or bile washes back into the esophagus. Over time this acid erodes the lining of the esophagus, resulting in discomfort. Complications can include esophagitis, Barrett’s esophagus, and esophageal cancer.

What Do I Need To Do About It?

For mild and infrequent symptoms, nonprescription therapy is often enough:

• Avoid foods that induce reflux (coffee, fat, etc.).
• Avoid eating close to bedtime and lying down after meals.
• Eliminate smoking.
• Reduce/eliminate alcohol.
• Elevate your head during sleep.
• Lose weight.
• Take over-the-counter antacids as needed (anyone taking over-the-counter antacid medication for more than two months should see his or her doctor.)

For patients with severe or frequent symptoms of esophagitis, see your doctor so he/she can diagnose and treat you appropriately. Initially, over-the-counter antacids may help. Losing weight, eliminating smoking and alcohol and avoiding eating too close to bedtime will also help. If over-the-counter remedies don’t relieve your symptoms, then prescription proton pump inhibitors (PPI) will most likely be used.

Where Can I Get Help?

Cascade Hernia & Surgical Solutions provides an array of surgical interventions to treat GERD—safely and efficiently. Getting your surgery here means more convenience, privacy and individual attention at a lower cost than in a hospital setting. Ask your physician if you are a candidate for outpatient surgery.

Why Should I Pursue Surgery Now?

If you know you have a GERD problem, you can take control now. Planning your own surgery means lower costs, timing that works for you, and less risk for complications. Why wait for the next unpleasant surprise? Call Cascade Hernia & Surgical Solutions today!

Surgery to improve or prevent GERD has shown excellent results. Patients with GERD not well controlled with medicine alone, complicated GERD (severe esophagitis, Barrett’s or strictures), the presence of a hiatal hernia, and patients who are young and face life-long medication use are good candidates for anti-reflux surgery.

Surgeons use various surgical methods can fix GERD, including Hill Repair, Nissen Fundoplication or Toupet repair. Cascade Hernia & Surgical Solutions is one of a select number of facilities to offer an FDA-approved device called LINX®, which is sometimes used in more challenging cases for GERD.

MORE ABOUT GERD

What Causes GERD?

GERD results when a weak lower esophageal sphincter (LES) allows acid and bile to reflux—or flow back—from the stomach into the esophagus.

The LES is a muscle at the junction of the esophagus and stomach that functions as the body’s natural barrier to reflux. The LES acts as like a valve, allowing food and liquid to pass through to the stomach. Normally, the LES resists opening to gastric pressures to prevent reflux.

In people with GERD, the LES is weak and allows acid and bile to reflux from the stomach into the esophagus, often causing injury to the lining of the esophagus and symptoms such as heartburn, chest pain, regurgitation, sore throat and cough. Surgery repairs the LES to restore normal function.

What should I know about PPIs?

Proton pump inhibitors are a group of drugs that effectively block acid production in the stomach and relieve the symptoms of GERD. They are safe and generally well tolerated. Unfortunately, they are expensive and usually require an increase in dosage the longer you take them. If you are not able to manage your GERD with diet and medication, you may be a candidate for surgery.

You might experience these issues when treating GERD with medication alone:

• Incomplete relief of symptoms.
• Development of a stricture or esophageal narrowing.
• Barrett’s Esophagus,
• Relapse of symptoms after discontinuing medical treatment (after at least eight weeks of medication).
• Intolerable side effects from GERD medication.

Side effects of long-term medication use can include dementia, renal failure, stroke, osteoporosis, and infectious diarrhea.

What if my symptoms persist?

If symptoms persist while you are on medication, you need to see your doctor. He or she may recommend additional testing to confirm the diagnosis and exclude complications of GERD (such as stricture or Barrett’s), or a more serious problem.

What types of surgery are available for GERD?

The most clinically effective and proven treatment for severe or complicated GERD is surgery. Gastrointestinal surgeons have performed this surgery for more than 40 years. Recent innovative surgical techniques have allowed surgeons to perform this operation laparoscopically (use of very small incisions, special instruments, and a video camera).

What is LINX?

LINX® is an implant device placed around the esophagus just above the stomach using a common, minimally invasive, surgical technique called laparoscopy. It is made of magnets connected by titanium wires, and the magnetic attraction between the beads is designed to help keep the weak anti-reflux valve (LES) closed to prevent reflux. Swallowing forces temporarily break the magnetic bond, allowing food and liquid to pass into the stomach. Magnetic attraction closes the LES after swallowing to reinforce the body’s natural barrier to reflux. Patients receive general anesthesia during the procedure, which usually takes less than one hour. Once implanted, the device will begin working immediately.

The Linx device now has been shown to have a higher failure rate than any of the other standard anti-reflux procedures and has a predictable rate of reoperation to remove the device. Occasionally, it also erodes into the esophagus. The major indication for a Linx device is prior failed operations and patients with conditions that have ongoing vomiting, as well as intractable acid reflux disease.

What is Laparoscopic Hill Repair?

A Hill Repair restores normal anatomy through repairing the hiatal hernia and the weak LES. The result is normal anatomy and normal function. Surgeons using the laparoscopic technique make five small incisions in order to perform the surgery. The Hill Repair has the longest published follow-up rate: 88 percent of patients have discontinued GERD medication and are satisfied 17 years after surgery. Most surgeons have little experience with the Hill Repair, but Dr. Wright has performed more than 1,500 of these procedures.

What is a Laparoscopic Fundoplication?

A Laparoscopic fundoplication is a surgical procedure in which a portion of the stomach (the fundus) is wrapped around the lower esophagus in order to prevent reflux of gastric acid and fluid into the esophagus. The benefits of this surgical approach include a rapid recovery, minimal time in the hospital (usually less than 24 hours), and very little pain and scarring. Surgeons perform laparoscopic fundoplication by inserting very small instruments through four to five very small (less than ½-inch) incisions, including a telescopic camera that connects to a TV monitor. Most patients are able to leave the hospital the day after their surgery is performed.

Even though both the open and laparoscopic procedures make the same internal changes, the open approach to this operation requires a much longer incision than the laparoscopic approach. This translates to a longer hospital stay, more discomfort, and a longer recuperation period.

The two most commonly performed Fundoplications are:

• The Nissen Fundoplication –A complete (360 degree) wrap of the stomach around the esophagus
• The Toupet Fundoplication –An incomplete (270 degree) wrap of the stomach around the esophagus

Dr. Wright will help you choose which option is best for you based on the results of your testing. Most patients will undergo the Hill Repair because it seems to have the best results over the long-term. The top part of the stomach is wrapped around the esophagus, which forms a “valve” between the stomach and esophagus. This valve prevents acid from refluxing up into the esophagus, thereby greatly improving or preventing symptoms of GERD. In addition, the surgeon narrows the esophageal hiatus with stitches and repairs any hiatal hernia. The operation usually takes less than two hours to perform in routine cases.