Anti-Reflux Surgery Specialist

What is Gastroesophegaeal Reflux?

Anti-reflux surgery is used to treat gastroesophageal reflux disease, or GERD. This condition is also known as acid reflux disease. This condition is the result of a valve or sphincter at the top of the stomach that is weaker than normal.  This weakened valve allows acid and food from the stomach to travel back up into the esophagus and leads to irritation. The valve is an area of thickened muscle located where the esophagus passes through the diaphragm and enters the abdominal cavity and connects to the stomach.  That opening in the diaphragm muscle, called the “diaphragmatic hiatus,” is supposed to be relatively tight around the esophagus. In certain conditions, the diaphragm hiatus can widen to an abnormal size and when that happens it is called a hiatal hernia. A hiatal hernia allows the stomach to begin protruding through the diaphragm and into the chest cavity. It is often a combination of a weakened valve and a hiatal hernia that contribute to the symptoms of GERD.   

What are the Symptoms of Reflux?

Most patients report symptoms which include:

• Burning sensation or pain in top of the stomach and chest
• A sour taste in the back of the throat
• Bloating/swelling in the upper abdomen and being unable to burp
• A cough that doesn’t get better or keeps coming back after antibiotics
• An early sense of fullness despite only eating a small amount
• Difficulty swallowing foods and/or liquids

What Happens During Anti-Reflux Surgery?

During anti-reflux surgery any hiatal hernia, where the diaphragm muscle is widened and some of the stomach is herniated up into the chest, will be addressed. The stomach is brought completely back into the abdominal cavity and the opening in the diaphragm is narrowed with stitches to prevent the stomach from going back up into the chest cavity. Then the topmost part of the stomach, called the fundus, is wrapped (like a hug) around the weakened valve at the bottom of the esophagus to provide it with more strength. In this way, when the stomach squeezes, instead of acid shooting up through the weakened valve and into the esophagus like before, now that same squeeze will help the valve squeeze closed and stop the acid from reaching the esophagus and keep it in the stomach where it belongs. The doctor will perform this surgery using laparoscopic techniques. During the laparoscopic surgery, the doctor will:

• Make 5 tiny incisions spread across the belly

• Pass narrow tubes called trochars through the abdominal wall muscles

• Insert a thin camera, or laparoscope, and a few long instruments into the abdominal cavity through the trocars

• Use the camera and instruments to return the top of the stomach from chest into the abdominal cavity

• Repair the hiatal hernia, where the widened opening in the diaphragm muscle is narrowed to just wide enough to allow the esophagus to pass through  

• Wrap the top of the stomach around the bottom of the esophagus to provide added strength to the weakened valve

This type of surgery is preferred because it reduces post-operative pain, allows for quicker recovery and leaves minimal scarring.