Gastric anti-reflux surgery

What is gastroesophageal reflux disease (GERD)?

In gastroesophageal reflux disease (GERD) stomach acid flows back up into the esophagus. This causes discomfort and is often referred to as heart burn. GERD is a common disease with a prevalence of 15-25% in western countries. Risk factors for the development of GERD are overweight/obesity, smoking, hiatal hernias, and a positive family history for GERD. 

What are the symptoms of GERD?

The main symptom of GERD is heart burn. This might be worse at night or while lying down. Other possible symptoms may include a chronic cough, a hoarse voice, a bad breath and upper abdominal or chest pain. If any of the following symptoms occur, an urgent endoscopy should be performed: difficulty with swallowing (dysphagia), pain while swallowing (odynophagia) or gastrointestinal bleeding/anemia.

How is GERD diagnosed?

For the diagnosis of GERD prior to surgical treatment, the most important diagnostic procedure is esophagogastroduodenoscopy (endoscopy). During endoscopy, the existence of a reflux-esophagitis and other factors can be evaluated. Further important diagnostic modalities are a 24-hour-pH-metry and an esophageal manometry. During the 24-hour-pH-metry, the pH-value in the esophagus is measured during normal daily activities. This examination determines whether gastroesophageal reflux is present. The esophageal manometry is a very important diagnostic procedure to evaluate whether the esophageal motility during swallowing is normal. If not, a different disease such as an esophageal motility disorder (e.g. achalasie) may be the reason for the patient’s symptoms. It is very important to distinguish GERD and esophageal motility disorders, as these diseases have common symptoms but are treated in very different ways.

How is GERD treated?

Most patients with GERD are treated successfully with proton-pump inhibitors (PPIs) such as pantoprazol. Surgical treatment of GERD is a good therapeutic option in patients with refractory symptoms despite adequate PPI-treatment, complications of GERD (such as higher-grade esophagitis, strictures), intolerance towards PPIs or patients opting for fundoplication despite successful medical management of GERD. 

Surgical treatment of GERD (or hiatal hernia/up-side-down-stomach) is routinely performed in a minimally-invasive laparoscopic procedure. The standard treatment for GERD is a laparoscopic 360°-Nissen-Fundoplication. This procedure includes the reduction of a hiatal hernia, the closure of the hiatal hernia by cruroplasty and the creation of a circumferential fundoplication as an anti-reflux-barrier.