Acid Reflux Surgery
If you have experienced long-term heartburn, a specialist may recommend acid reflux surgery. However, surgery for acid reflux is highly controversial and the long-term effects of such a surgery are not well-documented.
In this article, you will discover reasons why surgery may be recommended, what the most common procedure is and the pros and con of having GERD surgery.
Reasons for Having Acid Reflux Surgery
Surgery is only typically recommended in the most extreme cases of Gastroesophageal Reflux Disease (GERD). Reasons for surgery recommendation may include:
- Reductions to the patient’s quality of life due to heartburn symptoms
- Failure of medication to control the condition
- Congenital (genetic) disorders
- Noted damage to the esophagus, such as Barrett’s Esophagus
- Family history of esophageal cancer
- Doctor discretion based on individual circumstances
You do not need to have every check-point on the list to be a surgery candidate. For example, if heartburn medicaiton is not working for you and GERD is significantly reducing your quality of life, your doctor may recommend Acid Reflux surgery in the absense of esophageal damage, simply to improve your quality of life.
On the other hand, even if GERD is not significantly impacting you, if you have regular GERD, evidence of esophageal damage, and a family history of esophageal cancer, your doctor may urge you to get this surgery performed, regardless of the current condition of your esophagus.
Furthermore, some doctors may not recommend acid reflux surgery in any situation simply because its long-term efficacy remains unproven; not necessarily because it does not work but rather just due to a lack of any real data.
Types of GERD Surgery
There is only one primary type of surgery to reduce reflux and it involves creating an artificial valve at the entrance to the stomach.
Most cases of acid reflux are thought to stem from an improperly functioning lower esophageal sphincter (LES). The LES normally forms a 1-way valve, allowing food and drink to enter the stomach but not allowing anything to leave. In GERD, this valve allows the contents of the stomach to leak into the esophagus.
To create an artificial valve, a surgeon will wrap a portion of the stomach around the sphincter and suture it in this position, relying on the elastic properties of the stomach to form a tight but passable valve around where the LES is.
The smooth muscle in the esophagus is strong enough to push food and drink through this new valve, but the valve should be tight enough to prevent GERD from occurring.
For details on the differences between specific acid reflux surgeries, see this article comparing Nissen Fundoplication vs Anterior Fundoplication.
Pros and Cons of GERD Surgery
The pros and cons of this surgery are simple. The pros are that it seems to be effective for most people, at least in the short term.
The cons are that this surgery, like any surgery, can be fairly expensive and comes with some risk and down-time (although recovery is quite fast with the laparoscopic procedures). Getting surgery is a much bigger commitment than using a few simple heartburn remedies.
The real con with acid reflux surgery is that the long-term success rates and possible side effects are not well-documented. The surgery is fairly new and data on a large number of patients is not yet available. It is possible, given the elastic nature of the stomach, that the portion of the stomach used to create the artificial valve will stretch and become lax over time, resulting in the return of heartburn.
The most common side effect that negatively impacts quality of life (and may even require corrective surgery) is the inability to belch. This occurs when the surgery causes the lower esophagus to be so tight that you are unable to belch (which is necessary to remove excess gas from the stomach). This means that if you swallow air when you talk, eat, or drink, you will be in a lot of pain (and have a lot of gas). Sodas and other carbonated drinks will be strictly off limits as well.
The Bottom Line on GERD Surgery
The bottom line on GERD surgery is that it seems to be effective in the short-term, but the long-term effects are unknown. Your doctor may advise surgery as a last resort if medication and lifestyle changes are not enough.
It is my opinion that the biggest thing lost on most GERD and heartburn sufferers that having reflux is for many an indicator of underlying health problems and unhealthy lifestyle choices. Improving the quality of your diet, avoiding drinking and smoking, and losing excess body fat can significantly reduce reflux and improve the quality and length of your life.
Getting surgery because you have a genetic anomaly that causes excess stomach acid to be produced or the Lower Esophageal Sphincter to not function properly is completely understandable. Getting surgery because you have advanced esophageal damage also makes sense. Getting acid reflux surgery because you do not want to go on a diet or quit smoking is simply irresponsible.