Gastroesophageal Reflux Disease: Surgical Therapy

Indications of interventional or surgical treatment:

  • Taking PPI do not lead to appropriate therapeutic success, that is, acid reflux is not sufficiently suppressed (due to”fast metabolizer”).
  • Presence of a clear non-acid reflux (mixed reflux) in addition to an acid reflux component.
  • Despite elimination of heartburn (pyrosis), the quality of life is impaired (volume reflux) due to a continuing tendency to regurgitation (backflow of food pulp from the esophagus into the mouth).
  • Taking proton pump inhibitors (proton pump inhibitors, PPI; acid blockers), H2 blockers or antacids are effective, but the patient refuses to take these drugs continuously.

The procedures

For interventional procedures, see “Further therapy” below.

Surgical procedures are used in severe forms of gastroesophageal reflux disease:

  • Antireflux surgery:
    • Laparoscopic hiatoplasty (diaphragmatic suturing via laparoscopy) or
    • Fundoplication, i.e., formation of a sleeve completely around the lower portion of the esophagus (food pipe; 360°) to prevent reflux (backflow) of gastric acid [standard surgical therapy; reflux control 85-95%]Mandatory surgical indications: Type II/III hernias (hiatal hernias), upside-down stomach (synonym: thoracic stomach)Fundoplication can be performed classically surgically and endoscopically.
  • Implantation of an antirefux system – to mechanically strengthen the lower sphincter region (sphincter region).
  • Pacemaker system – to stimulate the lower esophageal sphincter.
  • Dilatation of stenoses (narrowings) – e.g. by means of balloon dilatation (dilatation with the help of a liquid- or air-fillable balloon catheter).
  • Laser therapy for Barrett’s syndrome – laser ablation / “laser vaporization” of altered cells (precancerous!).
  • CPAP (Continuous Positive Airway Pressure) – respiratory therapy for sleep apnea syndrome.

Note: Esophageal manometry should generally be performed before antireflux surgery to rule out achalasia (chronic dysfunction of the esophagus).

Further information

  • In a comparative study, placement of a transoral fundoplication relieved patients with gastroesophageal reflux disease (Gerd) of heartburn more often than continued PPI (proton pump inhibitor; short for proton pump inhibitors; acid blockers) medication.
  • Despite antireflux surgery, a large proportion of patients with gastroesophageal reflux disease require PPI medication again in the medium term: one in two patients in the medium term and four in five patients intermittently.