Gastroesophageal reflux disease (GERD): surgical treatment

When deciding on the question of surgical treatment, other possibilities for treating patients should be carefully considered, since the symptoms can be associated not with GERD, but with other diseases.

The aim of operations aimed at eliminating reflux is to restore the 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;
• esophagus Barrett (due to the danger 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 stricture, repeated bleeding); Barrett's esophagus with the presence of high-grade epithelial dysplasia (because of the risk of malignancy).

The first fundoplication Nissen performed in 1955 with reflux-esophagitis and GAP. To date, this surgery is most common as a method of surgical treatment of GERD. And yet, despite the rather high and stable curative effect, open antireflux surgery has not been widely used, mainly because they all have high traumatic and almost unpredictable results.

The following postoperative complications are possible:

• Syndrome of bloating. It is characterized by a feeling of saturation in the upper abdomen immediately after eating. It arises from the elimination of a burp produced by a more powerful lower esophageal sphincter. Particularly predisposed to it are patients who smoke or consume large amounts of carbonated drinks. This syndrome usually subsides in a few months.
• Postoperative dysphagia is noted in 1/3 patients. It is associated with postoperative edema and passes by itself.

Patient education

The patient should explain that GERD is a chronic condition, usually requiring prolonged maintenance therapy with proton pump inhibitors to prevent complications.

It is advisable for the patient to follow the recommendations for lifestyle changes.

The patient should be informed of possible complications of gastroesophageal reflux disease and recommend that he consult a doctor if symptoms of complications occur:

• dysphagia or loneliness;
• bleeding;
• loss of body weight;
• early sense of satiety;
• coughing and attacks of suffocation;
• pain in the chest;
• frequent vomiting.

Patients with prolonged uncontrolled symptoms of reflux should explain the need for endoscopy to detect complications (such as Barrett's esophagus), and in the event of complications, the need for periodic endoscopic or biopsy examinations.

[1], [2]