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Anti-reflux surgery is reserved for people with severe acid reflux.
Gastroesophageal reflux disease is a term doctors use to describe persistent symptoms or complications, such as recurrent heartburn or esophageal ulceration, caused by acid reflux. GERD, which affects up to 20 percent of adults in the Western world, differs from acid reflux, which occurs in nearly half of American adults at least once monthly. When medical therapy for GERD fails, your doctor may recommend anti-reflux surgery.
Risks During Surgery
Certain risks, such as bleeding, infection, punctured bowel or anesthesia complications, must be taken into account whenever you're considering any type of abdominal surgery. While the rates of such complications vary from one hospital to the next, they are generally quite low. For example, the risk of developing a surgical site infection is around 1 to 3 percent in developed countries. Some risks, such as bleeding or infection, may be heightened by underlying medical conditions, such as obesity or diabetes.
Since Rudolph Nissen first introduced his fundoplication procedure in 1958, this form of anti-reflux surgery has gained broad acceptance and undergone numerous modifications. Fundoplication, which nowadays is usually performed through a laparoscope, entails wrapping a portion of your upper stomach around your lower esophagus to prevent reflux. Fundoplication provides patient satisfaction in 85 to 90 percent of cases, according to a 2009 review in the "Journal of Gastrointestinal Surgery." In the remaining 10 to 15 percent, reflux symptoms persist or complications occur. The most common complications following fundoplication include difficulty swallowing and вЂњgas-bloatвЂќ syndrome, which is characterized by abdominal bloating and an inability to belch.
The most recent developments in anti-reflux surgery involve methods in which the valve between your lower esophagus and stomach is rebuilt or reinforced, either by placing stitches in your esophagus or heating the junction between your esophagus and stomach. As with fundoplication, there is a small risk for puncturing the esophagus or stomach, anesthesia complications, bleeding or postoperative infection. Although there are insufficient data to determine the long-term safety or effectiveness of these newer approaches - Endocinch, Plicator, ELF and Stretta are several examples - they appear to improve symptoms for at least 60 percent of patients. Even with these newer procedures, however, serious complications and even rare fatalities have occurred.
GERD is a very common problem. For the majority of people who have GERD, medications and lifestyle changes - weight loss, dietary modifications and smoking cessation, for example - are sufficient for controlling symptoms. Anti-reflux surgery is reserved for people whose symptoms persist or who develop GERD-related complications, such as esophageal inflammation or precancerous changes, despite medical therapy. Your doctor can discuss your options and help you decide which treatment is best for you.