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Gastroesophageal reflux disease (GERD) - Surgical treatment
Last reviewed: 06.07.2025
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When deciding on surgical treatment, other treatment options for patients should be carefully considered, since symptoms may be due to conditions other than GERD.
The goal of operations aimed at eliminating reflux is to restore normal function of the cardia.
Indications for surgical treatment:
- failure of conservative treatment for 6 months regardless of the presence or absence of a hiatal hernia;
- complications of gastroesophageal reflux disease (strictures, repeated bleeding);
- frequent aspiration pneumonia;
- Barrett's esophagus (due to the risk of malignancy);
- combination of GERD with bronchial asthma refractory to adequate antireflux therapy;
- the need for long-term antireflux therapy in young patients with GERD.
Indications for surgical treatment of gastroesophageal reflux disease
Ineffectiveness of adequate drug therapy; complications of gastroesophageal reflux disease (esophageal strictures, repeated bleeding); Barrett's esophagus with high-grade epithelial dysplasia (due to the risk of malignancy).
The first Nissen fundoplication was performed in 1955 for reflux esophagitis and hiatal hernia. To date, this operation is the most common method of surgical treatment of GERD. And yet, despite the fairly high and stable therapeutic effect, open antireflux operations have not become widespread mainly due to the fact that all of them are highly traumatic and have a virtually unpredictable result.
The following postoperative complications are possible:
- Bloating syndrome. Characterized by a feeling of fullness in the upper abdomen immediately after eating. Occurs as a result of eliminating belching by surgically creating a more powerful lower esophageal sphincter. Patients who smoke or drink large amounts of carbonated beverages are especially susceptible to it. This syndrome usually subsides after a few months.
- Postoperative dysphagia is observed in 1/3 of patients. It is associated with postoperative edema and resolves on its own.
Patient education
The patient should be advised that GERD is a chronic condition that usually requires long-term maintenance therapy with proton pump inhibitors to prevent complications.
It is advisable for the patient to follow recommendations for lifestyle changes.
The patient should be informed about possible complications of gastroesophageal reflux disease and advised to contact a doctor if symptoms of complications occur:
- dysphagia or odynophagia;
- bleeding;
- weight loss;
- early feeling of satiety;
- coughing and asthma attacks;
- chest pain;
- frequent vomiting.
Patients with long-term uncontrolled reflux symptoms should be advised of the need for endoscopy to detect complications (such as Barrett's esophagus) and, if complications occur, the need for periodic endoscopic or biopsy examinations.
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