Surgery to Treat Reflux
Reflux at its simplest definition is when stomach contents regurgitate up towards the mouth. If the reflux reaches the throat level, it can cause a multitude of symptoms that a patient may not necessarily consider to be associated with reflux. More often, a patient may erroneously assume their throat symptoms are due to infection or post-nasal drainage.
Reflux that reaches the throat area or higher is known as laryngopharyngeal reflux or LPR.
Assuming all medications and non-surgical interventions have been tried and failed and workup confirms the presence of laryngopharyngeal reflux, surgery may be required to resolve a patient's persistent throat problems. Surgery is also the definitive management of non-acid reflux.
The surgery, regardless of the approach, attempts to tighten the valve between the stomach and esophagus. This tightening procedure is accomplished either by magnetic breads (linx system) or a maneuver known as a stomach wrap (fundoplication) which is analogous to cinching a belt to make an opening smaller.
Image modified from Wikipedia
There are 4 different flavors of reflux surgery.
• Open approach where one long incision is created over the belly... this approach is hardly ever performed anymore and will not be discussed further.
• Laparoscopic Nissen Fundoplication: This approach uses tiny cameras and instruments inserted through multiple small incisions over the belly. There is a variation of the Nissen Fundoplication called the Toupet Fundoplication which is meant for patients with both reflux and ineffective esophageal motility.
• LINX Reflux Management System: Uses magnetic beads to replicate the normal opening and closing of the stomach valve. Addresses many of the shortcomings of fundoplication surgery including inability to vomit and burp. Company Info here.
• Trans-Oral Incisionless Procedures: This approach uses NO incisions over the belly. Rather, all instruments are introduced through the mouth and directed towards where the valve is located.
Laparoscopic Nissen Fundoplication
LINX Reflux Management System
Trans-Oral Incisionless Procedures
There are currently three different devices using different methods to perform valve tightening: Stretta, Esophyx, and SRS. The videos shown below illustrate Esophyx and Stretta. Although these methods require no incisions, it is felt that these procedures have less "durability" in that over time, reflux symptoms may unfortunately recur at a higher rate compard to LINX and formal Nissen fundoplications.
Most general surgeons know how to perform a standard laparoscopic nissen fundoplication. However, only a few are familiar with how to perform the incisionless or LINX methods.
Workup Prior to Surgery
A patient must try non-surgical medical interventions first including:
- Stress Reduction: Stress increases risk of GERD and LPR by stimulating acid production in your stomach.
- Drink alkaline water (pH>8)
- Avoid the following foods
- Spicy, acidic and tomato-based foods like Mexican or Italian food.
- Acidic fruit juices such as orange juice, grapefruit juice, cranberry juice, etc..
- Fast foods and other fatty foods.
- Caffeinated beverages (coffee, tea, soft drinks) and chocolate.
- Adjust your meals:
- Do not gorge yourself at mealtime
- Eat sensibly (moderate amount of food)
- Eat meals several hours before bedtime
- Avoid bedtime snacks
- Do not exercise immediately after eating
- Lose weight! Being overweight can dramatically increase reflux.
- Elevate the head of your entire bed 4-6 inches by placing books, bricks, or a block of wood under the legs of the bed to achieve a 20 degrees or more slant.
- Avoid tight belts and other restrictive clothing.
- Stop smoking! Smoking dramatically increases reflux.
If these conserative measures do not adequately address LPR, there are medications one can take. Such medications include proton pump inhibitors like Prilosec, Nexium, or Prevacid (which are over-the-counter) as well as protonix, aciphex, etc as well as H2-blockers like zantac, pepcid, axid, etc. Be aware that these medications typically only work for acid reflux. If you are suffering from non-acidic reflux, surgery usually is required.
At a certain point, tests may be obtained to further evaluate a patient's reflux and is required prior to surgical consideration.
Related Blog Articles
- Sodium Alginate to Treat Non-Acid Reflux
- Do Reflux Medications Increase Risk of Esophageal and Throat Cancer?
- Reflux (Acid, Non-Acid, Mixed Types) in Neonates & How It May Also Apply to Adults
- Does Drinking Alkaline Water Help With Reflux?
- Reflux Medications Linked to Heart Attacks: Not as Bad as You Think
- What is Considered a Normal Number of Reflux Episodes?
- How Does Alginate Help Reflux?
- Laying on Right Side Worsens Acid Reflux!
- Does Drinking Alkaline Water Help With Reflux?
- Mattress Wedges for Reflux Treatment
- Gaviscon Advance by Reckitt Benckiser
- Gaviscon Advance for Non-Acid Laryngopharyngeal Reflux (LPR)
- New Video of Phlegmy Throat
- Saliva Test for Laryngopharyngeal Reflux (LPR)
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