GERD-Laparoscopic Management

Many patients with GERD fail to improve permanently with medical treatment only. Very often, soon after stopping, or even decreasing the daily medication, symptoms come back, strong as before. This usually leads to repeated endoscopies to follow the esophagitis, change of medication regimen, and so forth. Patients keep on carrying on with their disease, keep on consuming various kinds and quantities of pills, and keep living not a normal life, since they cannot eat anything they want, at the time they want it, and they need to sleep with their head up at night. In such patients and in those with food reflux and the risk of aspiration, we usually suggest to them to consider surgical treatment. Today, this is accomplished with a laparoscopic operation, an operation that is, which is performed through four very small (1 cm) incisions and can be performed as an outpatient, or one night stay in the hospital. During this laparoscopic procedure, the hiatal hernia is repaired and the function of the lower esophageal sphincter (LES) is reconstituted. The final physiologic result of this procedure is that reflux ceases to exist, which essentially is the treatment of the very cause of GERD, not just of its symptoms. With this operation (called: Laparoscopic Nissen Fundoplication) patients also get rid of the esophagitis and the future risk to develop cancer of the esophagus, and of course they do not need antacids or other medications any more. Laparoscopic Fundoplication requires excellent skills in advanced laparoscopic surgery and extensive knowledge and experience on the physiology, motility and surgery of the esophagus. Before a planned operation, patients should be thoroughly examined by esophagogastroscopy, as well as some other very specific tests, such as 24-hour pH monitoring and esophageal manometry. These very special tests should be performed and interpreted by a team specifically experienced on these issues. The results of these studies dictate not only the exact stage of this disease, but also the specific type of the laparoscopic fundoplication that each individual patient would benefit from. Laparoscopic Fundoplication is the modern, simple, and minimally invasive procedure, which offers definitive treatment of GERD and its possible complications.