The standard surgical treatment for GERD is fundoplication. The goals of this procedure are to:
- Increase LES pressure and prevent acid backup (reflux)
- Repair a hiatal hernia
There are two primary approaches:
- Open Nissen fundoplication (the more invasive technique)
- Laparoscopic fundoplication
In general, the long-term benefits of these procedures are similar. Fundoplication relieves GERD-induced coughs and other respiratory symptoms in up to 85% of patients. (Its effect on asthma associated with GERD, however, is unclear.) It may enhance stomach emptying and improve peristalsis in about half of patients. (It may actually cause abnormal peristalsis in some patients, although in such cases the problem does not appear to be very significant.)
Fundoplication has some significant limitations and postoperative problems. For example, many patients still require anti-GERD medications or experience new symptoms (such as gas, bloating, and trouble swallowing). Most of these new symptoms occur more than a year after surgery. Fundoplication does not cure GERD, and evidence suggests that the procedure does not reduce the risk for esophageal cancer in high-risk patients, such as those with Barrett's esophagus. However, fundoplication has very good long-term results, especially when performed by an experienced surgeon, and few patients need to have a repeat procedure.
Candidates. Fundoplication is recommended for patients whose condition includes one or more of the following:
- Esophagitis (inflamed esophagus)
- Symptoms that persist or come back in spite of antireflux drug treatment
- Failure to gain or maintain weight (in children)
Fundoplication has little benefit for patients with impaired stomach motility (an inability of the muscles to move spontaneously).
The Open Nissen Fundoplication Procedure. Until recently, the 360° Nissen fundoplication was the fundoplication procedure most often used for GERD. This is called an open procedure because it requires wide surgical incisions.
Review Date: 07/11/2010
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.