Heartburn, also known as acid reflux, occurs when stomach acid backs up into the esophagus, causing a burning sensation in the chest or throat. It is a common symptom of gastroesophageal reflux disease (GERD). Other symptoms of GRD include regurgitation, bloating, and trouble swallowing (dysphagia). Less common symptoms include esophageal spasms which can mimic the chest pain like a heart attack, as well as increased fatigue from bleeding in the stomach, shortness of breath hoarseness, excessive through clearing, and chronic cough of unknown cause.

There are several types of medications available to manage GERD symptoms. These include antacids, H2 blockers, and proton pump inhibitors (PPIs). PPIs are more effective but may have more side effects.

While medications for heartburn are generally safe, they can sometimes cause side effects such as headache, nausea, diarrhea, and constipation. It's essential to discuss any concerns or side effects with your doctor.

Anti-reflux surgery, such as laparoscopic fundoplication, can help strengthen the lower esophageal sphincter and prevent stomach acid from refluxing into the esophagus. This can provide long-term relief from GERD symptoms and reduce the need for medications. You can stop medications immediately after surgery, which saves more money in the long-term*.

Nissen fundoplication is a minimally invasive surgery which wraps the uppermost part of the stomach 360° around the lower portion of the esophagus. This creates a one-way valve where food can go down, but stomach contents cannot come back up. This is the most effective form of anti-reflux surgery, but it does come with side effects occasionally of bloating, and gassy feelings. After the surgery, patients will not be able to belch or vomit because of the one-way valve.

Partial Fundoplication is when the uppermost portion of the stomach (the fundus) is wrapped partially around where the esophagus meets the stomach. If the stomach is wrapped on top of the esophagus, it is called a Dor fundoplication. If it is wrapped in the back, it is called a Toupet fundoplication. Dor fundoplication is only used in special circumstances; Toupet is generally a better choice for managing GERD symptoms. Patients who receive a partial fundoplication generally report less symptoms of bloating or gassiness after surgery. Patients are also able to belch and vomit after surgery, something that is not possible with a full Nissen fundoplication.

This is a device first used in 2008 to prevent reflux. It looks like a lamp pull shade, with a string of metal beads which are magnetic, linked together. The ring can expand or contract. So when you swallow, the ring will open, allowing the food to go down. Then at rest, the ring is in the closed position with the magnets touching each other. This prevents reflux from happening.

LINX allows patients to belch and vomit, which is something that they cannot do with the full Nissen fundoplication. LINX allows the same relief of symptoms without the side effects of a Nissen. There is also some early evidence that LINX can reverse the effects of Barrett's esophagus, allowing the lower esophagus to heal. This has never been shown with fundoplication.

Around 5% of all devices are eventually removed. This is because either the patient has some difficulty swallowing (dysphagia), or the patient feels that they don't have enough GERD relief with the device. LINX Is easy to remove if necessary and safe. The rate of erosion, where the device damages the esophagus, is very low at 0.5%.

Most patients undergoing laparoscopic anti-reflux surgery are discharged from the hospital within 1 day after the procedure. Patients who receive the magnetic sphincter augmentation (LINX procedure) can go home on the same day.

Patients do not feel much pain because the area where the operation takes place on the inside is quite small. Additionally, we do a nerve block during the surgery, which blocks pain from the the skin incisions for the first 12 hours. Most patients only require one or two oxycodone at home, then pain is well managed with just over the counter Tylenol.

Following anti-reflux surgery, you will need to follow a modified diet while the lower esophagus heals and swelling goes down. The first two days you will only be drinking clear liquids. This includes juice, coffee without milk, tea without milk, Jello, any liquids you can see through. On the 3rd and 4th day you can have any liquids you like. On the 5th day, you can advance to a soft diet which includes anything that is blended or mashed up (think anything that a person without teeth could eat: mashed potatoes, tofu, tuna salad, tomato soup, etcetera). I allow patients to advance from this point on their own, with a plan usually to be back to a normal diet within 1-2 weeks. As general advice, things that require the most amount of chewing are more likely to have trouble passing through the lower esophagus. The hardest things to successfully swallow are thick fibrous vegetables like broccoli or string beans. The hardest meat to swallow is cooked steak. Advance from the soft and blended foods slowly and carefully, try little bites first as an experiment. Call us IMMEDIATELY if food has been stuck for more than 30 minutes and will not go down. Carbonated beverages and drinking with a straw will increase the likelihood of you having increased bloating sensation and discomfort. We recommend that you stay away from these.

If you have the LINX procedure, you are encouraged to immediately begin having bites of soft food. The rule is you can safely eat anything that you can cut with a fork (a good excuse to have cake!). Frequent bites of meals every hour are recommended in order to stretch the LINX device open. In addition to these small snacks every hour, you are encouraged to have four to six small meals per day. You can slowly advance back to a normal diet by one to two weeks after the surgery. You may notice that you have increasing difficulty swallowing around week 3 to 8 after the surgery. This is because scar tissue is forming in the area. The way to minimize this from occurring is to stick to regular snacks every hour. Rarely, it may be necessary to stretch the esophagus open with a balloon through an endoscope which is passed through the mouth. This takes 10 minutes and is very safe. Patients will go home on the same day.

The goal is for you to never need surgery again. However, if necessary, the surgery can be revised or undone. If you received a LINX or a fundoplication and want to switch to a different type of anti-reflux surgery later, it is very doable. Most patients who receive these surgeries will never have another surgery again. There is a rate of recurrence of hiatal hernia in the literature which varies from 9% to more than 20% at 10 years. Many of these patients will be asymptomatic, but some will have new symptoms requiring revisional surgery. It's still better to have the surgery, because it prevents the problem from getting out of hand. Waiting to have surgery until the hiatal hernia is huge makes the patient more miserable, the likelihood of long-term success much lower, and makes the operation more challenging and slightly riskier. A recent study has demonstrated that even a paraesophageal hiatal hernia which does not cause symptoms still should be fixed. This has changed, as the surgery has become safer with time. Unless the patient is extremely frail, the surgery will prolong the patient’s life*.

We are specifically fellowship trained to handle this very complex operation. We handle simple small operations as well as the largest most complex revisional surgeries. Although the surgery takes place over a small area of your body, minor differences in how the procedure is performed can have a large impact on the patient's life, affecting their ability to swallow. It is therefore critically important to make sure that your surgeon performs these procedures regularly and has been well trained! Please contact us today to learn more!