Surgical Management of Gastroesophageal Reflux Disease

Abstract

The cornerstone of gastroesophageal reflux disease (GERD) symptom management includes lifestyle modification and medical therapy. Acid suppressing medications, such as proton pump inhibitors (PPIs), have shown great efficacy in achieving satisfactory symptom control for most patients. Development of complicated GERD while on appropriate medical therapy is a common indication for anti-reflux surgery. Patients with anatomic pathologies also often fail medical therapy and are good surgical candidates. Preoperative evaluation is very important. Anti-reflux procedures can be broken down into either gastric wraps, sphincter augmentation, endoscopic interventions, or gastric bypass. A practicing foregut surgeon should be able to provide a variety of options for anti-reflux surgery and tailor treatment for each individual patient. The Nissen Fundoplication has become one of the most commonly performed anti-reflux procedures to date. Complete 360-degree fundoplication should be avoided in patients with esophageal motility disorders, as it can lead to severe dysphagia. This has led to the modification of the Nissen fundoplication to partial fundoplication. Magnetic sphincter augmentation involves placement of a magnetic prosthesis around the distal esophagus to bolster the LES. The device used is the LINX Reflux Management System, which gained FDA approval in 2012. GERD disproportionately affects obese patients, with prevalence rates as high as 37-72%. Roux-en-Y gastric bypass has shown positive results in obesity and improvement or resolution of GERD symptoms at 1 year post-operative.