What’s the next step when you’ve tried adjusting your lifestyle and medication for gastroesophageal reflux disease (GERD). If it doesn’t seem to be managing your symptoms or discomfort well? It could be time to consider surgery. 

In this article, we will cover the surface-level knowledge on who qualifies for surgery, tests that might be required before antireflux surgery, the surgical procedure and aftercare during the recovery period.

Let’s start with what anti-reflux surgery is first, shall we?

What is Antireflux Surgery?

Surgery for GERD is often referred to as antireflux surgery which involves what is known as a fundoplication. A fundoplication’s function is to reinforce the lower oesophagal sphincter (LES) to recreate the barrier that stops acid reflux from occurring.

Commonly, this is done by wrapping a portion of the stomach around the bottom of the oesophagus in an effort to strengthen, augment or recreate the LES valve. The most common type of fundoplication is the Nissen fundoplication in which the stomach is wrapped 360 degrees around the lower oesophagus.

Most antireflux operations today are often performed using minimally invasive surgery called laparoscopy (also known as keyhole surgery). This technique utilises a small tube-like camera and several long, thin operating instruments to operate through a small incision. It is made in the abdomen of the patient. The small incision should leave less scarring and reduce the risk of complications post-surgery compared to traditional open surgery.

Testing Prior to Antireflux Surgery

Some tests are necessary to determine if a patient is a good candidate for antireflux surgery. The purpose of these tests is to identify objective evidence of acid reflux, evaluate coexisting diseases that may be contributing to the symptoms experienced, and correlate reflux with the symptoms experienced.

All patients should have an upper endoscopy done as a preliminary test. Additional testing could include a 24-hour pH test coupled with impedance and an oesophagal manometry. Here is a bit more information on each test:

Upper endoscopy

An upper endoscopy uses a small camera through the mouth and into your upper gastrointestinal tract to evaluate your oesophagus, stomach, and duodenum (the first part of your small intestine). 

This is usually done under light sedation, and the purpose of the endoscopy is to look for reflux-related damage and identify any alternative or coexisting diseases that may be contributing to symptoms reported by the patient.

This could mean looking for signs of damage like Barrett’s oesophagus, oesophagal ulcers, oesophagitis, and oesophageal strictures. Biopsies (tissue samples) of the oesophagus, stomach and duodenum are often obtained during this procedure.

24-Hour pH Test

This test involves inserting a catheter through a patient’s nose into the distal oesophagus above the lower oesophagal sphincter. The sensors in the catheter would detect signs of acid reflux, and if it correlates with the symptoms recorded during reflux episodes. 

This test is done on a 24-hour period while the patient is off their acid-suppression medication for better accuracy. The patient is allowed to continue their routine activities while this test is being done.

Oesophagal Impedance pH Study

Many physicians who utilise the 24-hour pH test would also couple the test with an impedance test. Oesophagal impedance detects fluid reflux regardless if it is acidic in nature or not. Both acidic and non-acidic reflux events are measured this way. 

It would indicate if a patient has non-acidic or mildly acidic refluxes despite high doses of acid suppression medication (the strong dose of medication may not be a sustainable solution if there is still acidic refluxes present with medication).

Manometry

Oesophageal manometry measures the motor function of the LES and the oesophagus. This would indicate if the contractile function of the LES and/or oesophagus is contributing to the occurrence of acid reflux episodes.

If conditions satisfy the criteria to indicate surgery as a solution for the patient, then the physician can advise accordingly.

Recovery from Antireflux Surgery

If your antireflux surgery was done via laparoscopy, then it is likely you would be admitted in the hospital for 1-3 days for monitoring post-surgery. This observation period is to ensure you are free from nausea and vomiting. Then, you’re able to tolerate drinking enough liquids to stay hydrated. 

You might face some dietary restrictions after surgery. Typically, you would progress from a liquid diet to a solid diet over a 2-8 week period. It’s best to stick to the advice of your physician and be sure to ask as many questions as possible about the do’s and don’ts for the period of your recovery.

Outcomes of Antireflux Surgery

Generally, results are good after laparoscopic antireflux surgery. For short-term (1-5 years) and long-term (5-10 years) studies, a significant majority of patients report a reduction in symptoms experienced. Simailarly, an overall improvement in their quality of life after undergoing surgery. Almost all patients in those studies have also since been taken off their reflux medication after surgery.

Of course, it also helps if we keep up with better lifestyle choices after surgery to prevent a reoccurrence of symptoms or complications. Generally, you shouldn’t have to worry about reoccurrences post-surgery however that is a conversation to be had with your physician about best practices you can adopt to live your best life.

Final Thoughts

As far as surgical procedures go, antireflux surgery is not the most complicated of surgeries to execute and you shouldn’t have to worry about complications too much. To reiterate an earlier point – surgery should not be your first option if you are just beginning to experience acid reflux.

You would be better off trying to adopt better lifestyle choices like being mindful of your diet, managing your weight and keeping stress levels under control. If that doesn’t work, then you may explore medications you can purchase over the counter at pharmacies, or seek a prescription with your physician.

Only if symptoms persist, then have a consultation with a physician or seek a second opinion as well for you to better understand if surgery should be considered. To prepare for surgery, we have some tips you can follow here so you can have a better conversation with your physician.

If you live in Malaysia, and would like to consult a physician with experience in laparoscopy you could book an appointment here with our surgeon, Dr. Cha.

Cheers to the best of health!