Surgery to Treat Reflux or GERD
At Olde Del Mar Surgical we offer the acid reflux surgery, Nissen fundoplication, for the treatment of Gastroesophageal Reflux Disease.
Gastroesophageal reflux disease, or GERD, is caused by stomach acid and contents that travel up (backward) from the stomach to as far back as the throat. Under normal circumstances, a one-way valve called the lower esophageal sphincter (LES), located at the opening of the stomach, allows food coming down the esophagus into the stomach and keeps the stomach acid from escaping. A weakened LES, however, can allow stomach acid and food to travel back up (reflux). The most common cause of a weakened sphincter (and therefore of GERD), is a rupture of the muscles of the diaphragm, known as a Hiatal Hernia.
Treating GERD with Nissen Fundoplication
Many instances of GERD can be treated through various lifestyle changes and/or medications. However, when these non-surgical treatment options fail to bring relief for acid reflux, patients should consider undergoing laparoscopic Nissen fundoplication, which, in essence, recreates the valve between the stomach and esophagus. Surgery is also the ONLY way to fix a hiatal hernia. Patients with a large hiatal hernia or weakened muscles can sometimes benefit from a reinforcement of the hiatal hernia repair with mesh. Dr. Bhoyrul has among the largest experience in San Diego with this procedure.
The Nissen fundoplication procedure is a laparoscopic surgery performed at Olde Del Mar Surgical. Unlike open fundoplication, in which the procedure is performed through a single large incision, laparoscopic nissen fundoplication is performed through several tiny incisions in the abdomen. To begin the procedure, the surgeon carefully clears the junction between the esophagus and the stomach, the site of the lower esophageal sphincter. A simultaneous hiatal hernia is dissected out and repaired, with or without mesh, at this time. Next, the surgeon wraps the top part of the stomach, the fundus, around the esophagus, where the esophagus and the stomach meet. Depending on the patients’ symptoms and pre-operative tests, the surgeon may choose to make either a “full wrap” (wrapping the fundus all the way around the LES) or a “partial wrap” (wrapping the fundus only part-way around the LES). The wrapped fundus is then stitched permanently into place, providing support for the lower esophageal sphincter and helping to prevent reflux.