Anti Reflux Surgery

What is Reflux?

Reflux is the efflux of stomach acid and bile up into your esophagus causing a burning sensation (heartburn). Reflux is caused by a weakening of the muscle of your lower esophagus that normally prevents acid from coming back up, called the Lower Esophageal Sphincter (LES). Normally the LES acts as a one-way valve allowing passage of food and liquid into the stomach, but preventing stomach contents from flowing back into the esophagus. When this muscle weakens or becomes distorted (such as when a hiatal hernia occurs) then the mechanism begins to break down.

The gastric contents can, over time, cause damage to the esophagus (esophagitis) and ultimately lead to a condition where there is cellular changes (Barrett’s esophagus) and even lead to esophageal cancer in a small percentage of people.

What are the symptoms of Reflux?

Some of the common symptoms of reflux include:

  • Acid burning sensation
  • Fluid coming up into the mouth
  • Chronic cough
  • Voice changes from chronic acid exposure
  • Swallowing problems (in advanced disease)
  • Bad breath
Acid reflux medications

Acid reflux medications

What is the treatment of Reflux?

Treating reflux can be as follows:

  • Conservative measures
    • Elevating head of bed
    • Avoiding reflux triggering foods (coffee and chocolate are common examples as they cause the LES to relax)
    • Eat food that prevent reflux (by causing the LES to tighten) such as proteins
  • Medications
    • Proton Pump Inhibitors (PPI’s) are the most effective way to eliminate the burning from reflux. They work by halting acid production by gastric cells. They DO NOT stop the fluids from refluxing into the esophagus. They just take the acid away. They do not affect damage to the esophagus caused by bile reflux.
    • PPI’s must be taken DAILY or they will not work
  • Surgery
    • The simplest option is the LINX procedure (see below) which implants a “barrier” that prevents all refluxing of gastric content but allows normal swallowing of food and liquid
    • Nissen Fundoplication is the “classic” operation for reflux (see below)
    • Surgery will permanently stop all reflux into the esophagus, not just the acid sensation. It actually restores the barriers to gastric contents coming back up.
    • Surgery eliminates the need for daily or twice daily medications
    • Studies show that in the long run surgery saves money compared to medications
    • Surgery is the most effective way to reverse some or all of the cellular damage caused by chronic acid or bile reflux.
Nissen fundoplication

Nissen fundoplication

What is a Hiatal Hernia?

The natural opening in the diaphgram where the esophagus pierces in order to connect to your stomach is called the Hiatus. When this opening gets stretched out, the top of the stomach may actually bulge into your chest (a hiatal hernia). Depending on how much large the hernia is, more and more of the stomach and eventually even other organs (such as the colon or spleen for example) can herniated up into the chest.

The problem with hiatal hernias is that the negative pressure of the chest causes gastric contents to reflux up into the esophagus. Once the Lower Esophageal Sphincter is pulled up then it becomes ineffective against this negative pressure in preventing gastric contents from refluxing. Hence, hiatal hernias are one of the causes of Reflux.

Also, if enough stomach gets herniated into the chest then over time it may twist and cause problems with swallowing and passage of food. If it twisted enough it could cause an obstruction or in rare circumstances the blood vessels could get pinched off causing necrosis and perforation of the stomach which is a surgical emergency that could be deadly.

What can be done about Hiatal Hernias?

Hiatal hernias that are causing symptoms can be repaired surgically usually laparoscopically or robotically. This will reduce the stomach back into the abdomen where it belongs, restore the normal position of the LES, and stop reflux. The repair involves closing the hole around the esophagus more snug with sutures and sometimes a mesh for reinforcement. A fundoplication of the stomach (see below) is then done to help “bulk things up” so a recurrence is less likely.

What is LINX?

LINX device and procedure

LINX device and procedure

Linx solves reflux. It si a simple device that restores the reflux barrier. It is made up of titanium magnets that open to allow the passage of food or drink but do NOT open to allow gastric contents to reflux. It is placed with an outpatient laparoscopic surgery. There are not diet restrictions after the surgery and it has no side effects of significance. It is MRI (and airport security) safe!

Please click on for even more information. Please note that as of April 2016 this website does not yet list Dr. Gordon as a LINX provider but rest assure he is and he is the ONLY provider in Pinellas County.   Hopefully they will update this soon!

LINX is a great first-line surgical options for those who are failing medication therapy. Basically, if you continue to have reflux symptoms with daily PPI’s then LINX if likely right for you.

So if you are told to increase your PPI’s to twice per day, maybe it’s time to think about LINX.

Dr. Gordon is happy to talk to you about the workup and insurance process as well as pros and cons about surgery for reflux.

Nissen fundoplication

Nissen fundoplication

What is a Nissen Fundoplication?

The fundoplication is a surgery that “wraps” the top of your stomach around the lower esophagus to restore the LES function and prevent reflux. It is a laparoscopic and/or robotic procedure that cures reflux. It is especially good in conjunction with hiatal hernia repairs (LINX cannot be done in large hiatal hernias, but Nissen can). It often requires one night in hospital. There are some temporary diet restrictions while the surgery heals but then normal eating can resume without heartburn!

Dr. Gordon is happy to talk to you about the workup and insurance process as well as pros and cons about surgery for reflux.