Gastroesophageal Reflux Disease (GERD) or more commonly known as acid reflux and heartburn occurs when stomach acid or bile flows backward up into the esophagus, causing bothersome symptoms. Symptoms can be severe enough to mimic chest pain. The esophagus is the tube that connects the throat to the stomach. These reflux events are attributed to a weak lower esophageal sphincter (LES) that allows stomach acid to flow back. Many conditions have been associated with this muscle weakness such as diet, other medical problems, and being overweight.
Untreated, long-lasting and poorly controlled GERD can have serious adverse effects leading to severe inflammation of the esophagus, throat, stomach, lungs, vocal cords and it can even become a risk factor for Barrett’s esophagus which could lead to esophageal cancer – the fastest growing cancer in America. When symptoms occur often or are not controlled despite treatment, medical advice should be considered.
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Why SHAC for the treatment of Acid Reflux?
The surgeons at SHAC (Surgical Healing Arts Center) are recognized experts in the surgical treatment of Gastroesophageal Reflux Disease (GERD). They have successfully performed hundreds of operations to treat patients with Acid Reflux. Our surgeons often handle the worst types of acid reflux patients – they are truly well experienced and have helped numerous patients that other surgeons “would not have touched.”
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What are the symptoms of a hiatal hernia?
One of the most common symptoms in some cases causes stomach acid to leak into the esophagus. This is called acid reflux or gastroesophageal reflux, and it can cause symptoms such as
- Burning in the chest, known as heartburn
- Burning in the throat or an acid taste in the throat
- Regurgitation of food into the chest and throat
- Stomach or chest pain
- Trouble swallowing
- A raspy voice or a sore throat
- Unexplained cough
- In other rarer instances is associated with Asthma, Sinusitis, and upper respiratory complaints.
Are there different types?
Yes. A sliding hiatal hernia happens when the top of the stomach and the lower part of the esophagus squeeze up into the space above the diaphragm. This is the most common type of hiatal hernia. In many patients may go unnoticed, while in other patient is a source of significant symptoms, especially acid reflux. A paraesophageal hiatal hernia happens when the top of the stomach squeezes up into the space above the diaphragm. It can be serious if the stomach folds upon itself. It can also cause bleeding from the stomach, difficulty swallowing, chest pain, or trouble breathing.
Is there a test?
Yes. Most people learn they have a hiatal hernia when they are having tests to find the cause of stomach symptoms, or for other reasons. For instance, some people find out they have a hiatal hernia when they have an X-ray. Others find out when their doctor puts a tube with a tiny camera down their throat (called an endoscopy).
How are they treated?
People who have symptoms caused by a hiatal hernia can get treated for their symptoms. Treatment for symptoms involves taking medicines. People with a hiatal hernia may need surgery when the symptoms are too bothersome and not controlled with medications. For this surgery, the surgeon pulls the stomach back down and repairs the hole in the diaphragm, so the stomach does not slide up again.
At SHAC, we perform this procedure for repair of hiatal hernia with Minimally Invasive Surgical Techniques and in many cases, as an outpatient procedure with a rapid recovery and return to baseline.
Treatment Options for GERD and Hiatal Hernia
Gastric Fundoplication
Nissen fundoplication also referred to as a Lap Nissen, is a laparoscopic procedure performed for patients with gastroesophageal reflux disease (GERD). Many patients with reflux can be treated with medicines to decrease acid production in the stomach. This will minimize the damage to the esophagus from acid refluxed up from the stomach, and allow the esophagus to heal. However, some patients continue to have severe symptoms of either regurgitation or incomplete healing of their esophagus despite high doses of medical therapy. These patients should consider surgery as another option.
The problem lies at the junction of the esophagus and stomach where a muscular valve (sphincter), also known as the lower esophageal sphincter (LES) should prevent acid from flowing upwards. If this sphincter mechanism fails, acid is free to reflux up into the esophagus, causing damage. The surgery basically augments this lower esophageal sphincter (LES) by wrapping a portion of the stomach known as the fundus around the lower esophageal sphincter. If performed properly, this procedure will prevent further reflux with minimal side effects and eliminate the need for long term medical therapy.
One Size Does Not Fit All
Not all patients require a full wrap, 360-degrees (like a Nissen fundoplication). Your surgeons at SHAC, with the assistance of your gastroenterologist (GI specialist), will help determine if you require less of a wrap 270-degrees (Toupet fundoplication) vs. 180-degrees wrap. Customizing your surgery is a distinct advantage that your surgeons at SHAC routinely do to enhance the results of your surgery and minimize your complications.
LINX Procedure
Do you have Gastroesophageal Reflux Disease (GERD)? Want to leave the medication and pharmacy visits behind?
At SHAC, we offer the LINX Reflux Management System, a device that is FDA-approved to control the symptoms of GERD. With LINX, avoid the side effects of traditional surgeries for the treatment of GERD: bloating and a developed inability to vomit.
How does the LINX procedure work?
The LINX Reflux Management System is a flexible bracelet, approximately the size of a quarter, made of magnetic titanium beads that are implanted laparoscopically around the esophagus.
The system, once put in place, strengthens the lower esophageal sphincter—the muscle that allows food to enter and remain in the stomach. Food is better able to stay in the stomach because of the strong magnetic attraction among the beads of the device keep gastric pressures from causing reflux, yet still allows food to enter, and allows the patient to belch and vomit. Once placed in a patient’s stomach, the benefits of this device are immediate.
Do I qualify for a LINX device?
Answering “yes” to each the questions below may mean that you qualify!
- Have you never had bariatric or esophageal surgery?
- Are you 21 years or older?
- Want to stop taking GERD medication?
- Have you never had a hiatal hernia bigger than 2 centimeters?
- Is your body mass index less than 35?
How It Works
Advantages of the LINX procedure:
In comparison to other surgical treatments of GERD, the patients who choose LINX requires less time to recover and report less pain. Upon placement, the device begins working right away, eliminating bloating, heartburn, and gas, almost immediately.
Patients who choose LINX can also burp and vomit without harming the LINX device. If problems arise, the device is easily removed. Once the procedure is completed, patients are able to return to a normal, healthy diet.
Disadvantages of the LINX procedure:
Risks normally associated with surgery apply to the Lynx procedure, such as bleeding, infection, and risks associated with anesthesia. However, the risk of complications is quite low. Some side effects of this procedure include post-surgical pain, temporary bloating, and difficulty swallowing.
Patients who choose LINX must carry a cart that explains they have a metal device implanted in their body upon entering airport security. In only 3% of patients, the device had to be removed because it was too constricting.
Day of surgery:
You will be placed under general anesthesia during this procedure, which will be approximately one hour long. Your surgeon, experienced in laparoscopic anti-reflux procedures and specially trained in administering the LINX device, will make several tiny incisions in your abdomen. This is called a laparoscopic approach, which is minimally invasive. Your surgeon will wrap the bracelet-like device around your esophagus where it will stay due to its magnetic bond and eventual encapsulation by your own tissue. The device will begin working immediately!
After surgery:
To ensure that you experience no complications from the surgery or the administered anesthesia, patients are required to recover in the hospital overnight. Within 48 hours you will be able to eat soft foods. Slowly drink a few sips of water before consuming your first bite of food. Also, take small bites and chew thoroughly.
A few days after surgery, you will be able to return to work, and your normal activities as soon as taking medication for pain is no longer necessary. Strenuous activities like weightlifting should be avoided for about three to six weeks. Two weeks after your surgery, you will need to attend a follow-up appointment to ensure that your recovery is without complication. Call your doctor if any complications arise or if you have any questions!
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