Anti-reflux surgery

What is anti-reflux surgery?

Acid reflux is when the acid of the stomach, used to break down solid food for digestion, leaks out from the stomach and up the oesophageal track. While the occasional acid reflux is not something to be concerned about, acid reflux that happens constantly may be indicative of a disease called gastroesophageal reflux disease (GERD). It happens due to a failure of the lower oesophageal sphincter, which keeps the contents of the stomach and the oesophagus separated unless there is food passing through.

Anti-reflux surgery is a procedure to correct the weakness in the oesophageal sphincter. It is only considered once more conservative treatment, like lifestyle alterations and medication, do not yield results. There are various approaches that a surgeon may employ, depending on the anatomy and condition of the patient.

When is surgery for acid reflux needed?

Although acid reflux is to be expected periodically, if it becomes a frequent occurrence, the corrosive stomach acid starts to burn the oesophagus, inside the mouth and throat, and wear away at the enamel of the teeth.

Common symptoms of consistent acid reflux include yellowed teeth, unpleasant-smelling breath, chest pain, dry cough, bloating, hoarseness, and a swollen throat. Leaving acid reflux untreated greatly increases the risk of developing oesophageal cancer.

Initially, the course of treatment is for the patient to make changes to their diet – avoiding anything that is overly spicy, fatty, acidic, or ‘luxurious’ – in addition to stopping smoking, improving posture, and wearing loose, comfortable clothing. Medication to help with the chest pain, and neutralise, block, or reduce stomach acid can be purchased over-the-counter as well as prescribed by a gastroenterologist.

However, not all patients will respond to this avenue of treatment and therefore, will need to be considered for treatment. Other indications for anti-acid reflux surgery include those who are developing complications from prolonged acid reflux, such as:

• Barrett’s oesophagus
• Oesophageal stricture
• Respiratory dysfunction (cough, choking, dysphonia, postnasal drip, etc.)

Some patients may opt for surgery because they do not want to undergo prolonged medicinal therapy.

Types of anti-reflux surgery

The main methods for treating acid reflux surgically are fundoplication and magnetic sphincter augmentation.

Fundoplication, which is the most common, involves taking the top part of the stomach and wrapping it around the lower oesophageal sphincter to better support the muscle and reduce instances of reflux. The stomach wrap can be partial or complete. It can be performed laparoscopically, eliminating the need for a large incision site and minimising scarring while hastening recovery; another method, which has been recently developed, is entirely incisionless and called transoral incisionless fundoplication, with the procedure being conducted through the mouth using an endoscope. This is always partial, and while it may seem ideal, it is not suitable for many patients.

Magnetic sphincter augmentation involves the implantation of the LINX device, a ring of small magnets, in the lower oesophageal sphincter to support the muscles – strong enough to keep acid in the stomach, but weak enough that food can pass through. It can be implanted using laparoscopic or robotic techniques.

Anti-reflux surgery typically takes about two hours to perform, and patients are under a general anaesthetic. Most patients can leave the hospital on the same day or after one night of observation and recovery.

After anti-acid reflux surgery, patients can expect to enjoy a reduction of acid reflux and associated symptoms, though they are still encouraged to be careful with their diets.