March 24, 2017

Reflux Surgery Options – Pros and Cons

Nissen Fundoplication

The Nissen fundoplication is considered the “gold standard” for sphincter repair surgery. It is a minimally invasive surgical procedure that restores the damaged Lower Esophageal Sphincter (LES)  and therefore stops the reflux. This is accomplished by loosely wrapping the top part of the stomach (the fundus) around the lower esophagus.

Pros

  • High success rate.
  • Proven long term success.
  • Eliminates or reduces the need for medications.
  • Hiatal hernias can also be repaired during this procedure.

Cons

  • Possible side effects- bloating, flatulence, inability to vomit.
  • Surgery requires altering the anatomy of the stomach.
  • Must follow a special diet for approximately one month after surgery.

 

LINX Reflux Management System

The LINX Reflux Management System is a minimally invasive procedure in which a magnetic bracelet is surgically placed around the Lower Esophageal Sphincter (LES) to augment its previously impaired function. This device and procedure are relatively new (FDA approval in 2012) and its availability is limited to specific surgeons and locations. Availability will continue to increase as more patients seek out alternatives to a Nissen and more surgeons are trained.

Pros

  • High success rate in stopping reflux and eliminating PPI use.
  • Minimal side effects.
  • Safe.
  • Hiatal hernias can also be repaired during this procedure.
  • No alteration of the stomach anatomy.
  • May return to normal eating immediately.

Cons

  • Long term results yet to be confirmed.
    • 5 year study data is available.
  • Not all GERD patients are not candidates for LINX.
  • Requires an implant.

 

Transoral Incisionless Fundoplication (TIF)

During the TIF, a partial fundoplication (partial wrapping of the stomach around the esophagus) is created from inside of the stomach using a special device introduced through the mouth.  While the effectiveness of this procedure is still being debated, it is heavily marketed as a non-surgical alternative to the traditional Nissen fundoplication.

Pros

  • Minimal pain.
  • No scars.
  • Fast recovery time.
  • Very few side effects.
  • Most can reduce or discontinue medications and have improved symptoms.

Cons

  • Does not reliably stop the reflux.
  • Hiatal hernia cannot be repaired during this procedure.
  • Not sure about durability.
  • Must follow a special diet for a month after surgery

Stretta

During the endoscopic procedure, precisely controlled radiofrequency energy is delivered to the LES through a special catheter placed through the mouth.  Stretta is thought to make the damaged LES “stiffer,” and as a consequence partially restore its function. This procedure has been available for over 10 years and has not been widely utilized.

Pros

  • Minimal pain.
  • No scars.
  • Fast recovery time.
  • Very few side effects.
  • Most can reduce or discontinue medications and have improved symptoms.

Cons

  • Does not reliably stop the reflux.
  • Hiatal hernia cannot be repaired during this procedure.
  • Not sure about durability.