Understanding GERD Surgery

Expert Insights from USMD Hospital at Arlington

For most people, the occasional bout of acid reflux is just an uncomfortable nuisance. But for others, chronic acid reflux—also known as gastroesophageal reflux disease (GERD)—can severely impact quality of life and lead to serious complications.

When medications no longer control the symptoms, or when long-term damage is detected, surgery becomes an option. At USMD Hospital at Arlington, patients receive expert, compassionate care from surgeons on the medical staff, who are experts in minimally invasive surgical techniques.

What Is GERD Surgery?

Gastroesophageal reflux disease (GERD) is a condition in which stomach acid repeatedly flows back up into the esophagus, the tube connecting the mouth and stomach. This backwash, or acid reflux, irritates the lining of the esophagus. This reflux damages the esophageal lining, resulting in inflammation, pain, and potentially precancerous changes over time.

Most patients can manage their GERD with lifestyle changes and medications such as proton pump inhibitors, antacids or histamine (H2) blockers. However, not everyone finds relief. In those cases, patients may be advised to undergo GERD surgery, also referred to as reflux surgery or acid reflux surgery. This procedure corrects the underlying mechanical issues that cause stomach acid to flow backward into the esophagus.

GERD surgery is typically considered for:

• Patients who have persistent reflux symptoms despite medication
• Patients who prefer to avoid long-term medication use
• Individuals diagnosed with esophagitis (inflammation of the esophagus) or Barrett’s esophagus (a precancerous condition)
• Patients with large or recurrent hiatal hernias contributing to reflux
• People experiencing complications from GERD such as difficulty swallowing or respiratory issues

Patients who have undergone bariatric surgery, such as gastric sleeve or bypass, are usually not candidates for GERD surgery. These patients may need a different approach, which involves seeing a bariatric surgeon.

What Symptoms May Indicate the Need for GERD Surgery?

If you experience these symptoms persistently—even with medication—it may be time to consider a surgical consultation:

• Chronic heartburn or acid regurgitation
• Difficulty swallowing (dysphagia)
• Chest pain not related to the heart
• A chronic cough or hoarseness
• Frequent sore throats or laryngitis
• Sleep disruptions due to reflux
• Nausea, bloating, or a feeling of fullness

Untreated GERD can lead to complications such as esophageal strictures, ulcers, or even cancer. The esophagus adapts to repeated acid exposure by changing its cell structure, and those changes can lead to esophageal cancer.

What Is the Diagnostic Process for GERD Surgery?

Before recommending surgery, a thorough diagnostic evaluation is required to confirm GERD and assess the severity. Patients are typically referred to a gastroenterologist for:

• Upper endoscopy: to detect inflammation, ulcers, or esophageal damage
• Esophageal pH monitoring: to measure acid levels in the esophagus
• Manometry testing: to assess esophageal muscle function
• Barium swallow: to evaluate the shape and function of the esophagus and stomach

Depending on these results, the gastroenterologist may refer the patient to a surgeon for surgical evaluation.

What Does GERD Surgery Involve?

The most common procedure performed to treat GERD is fundoplication, a surgery where the upper part of the stomach (the fundus) is wrapped around the lower esophageal sphincter (LES) to reinforce the valve and prevent acid from traveling upward. The LES is the muscle that opens and closes to allow food to enter and stay in the stomach. When it works properly, the LES serves as the body’s natural barrier to reflux. When it does not, surgery may be in order.

Fundoplication may be performed in one of three different ways:

• Nissen Fundoplication: a complete 360-degree wrap
• Toupet Fundoplication: a partial posterior 270-degree wrap
• Dor fundoplication: a partial anterior 180-degree wrap

Another option is the LINX® Reflux Management System, which involves placing a small ring of magnetic beads around the LES to help it remain closed when not swallowing. In this minimally invasive surgery, the FDA-approved device is implanted laparoscopically.

Many patients with GERD also have a hiatal hernia, where part of the stomach pushes through the diaphragm into the chest cavity. In that case, the hiatal hernia must also be repaired during reflux surgery to ensure lasting results.

What Are the Types of GERD Surgery?

GERD surgery can be performed using several approaches:

1. Laparoscopic Surgery

This approach involves several tiny incisions in the abdomen through which a camera and surgical tools are inserted. This approach offers faster recovery, less scarring, and fewer complications compared to open surgery.

2. Robotic Surgery

Similar to laparoscopic surgery, robotic surgery uses small incisions but involves a robotic system that enhances precision. Some surgeons prefer this method for its dexterity and 3D visualization.

3. Open Surgery

This traditional method is rarely used today, typically for complex or redo surgeries. Open surgery involves a larger incision and a longer recovery period.

How Should Patients Choose a Surgeon for GERD Surgery?

Choosing the right surgeon is critical for long-term success. Patients should look for a surgeon with extensive experience in reflux procedures:

Patients should ask questions about:

• The number of GERD surgeries the surgeon performs each year
• The types of surgery that will be performed (laparoscopic, robotic, LINX)
• Recovery expectations and post-op support
• Complication and recurrence rates

What Is the Recovery Like After GERD Surgery?

Reflux surgery recovery typically involves a short hospital stay and a gradual return to normal eating and activity.

A typical recovery timeline includes:

• Hospital Stay: One night for observation
• First Day: Clear liquids only
• Next 2-3 Days: Full liquids like yogurt and applesauce
• 2 Weeks: Soft diet until follow-up visit
• 2–4 Weeks: Return to normal activity, avoiding heavy lifting or straining

Patients may experience temporary dysphagia (difficulty swallowing) due to swelling at the surgical site. This usually resolves in two to three weeks.

To prevent putting pressure on the surgical site and reduce the risk of hernia recurrence, patients should avoid vomiting, coughing, or strenuous activity during early recovery.

How Can Patients Prepare for GERD Surgery?

Preparation begins with a full evaluation, lifestyle adjustments, and a discussion with the surgical team. To get ready for GERD surgery:

• Stop smoking: Smoking delays healing and increases complication risk.
• Adjust medications: Your surgeon may recommend stopping certain drugs.
• Plan your diet: Stock up on liquids for the first week.
• Arrange for time off: Most patients need 1–2 weeks off work.
• Follow pre-op instructions: Including fasting and bowel prep if needed.

Understanding what to expect before and after surgery can make the recovery process smoother and less stressful.

What Are the Risks and Complications of GERD Surgery?

Although it is generally safe and effective, reflux surgery carries risks, as with any surgical procedure. These may include bleeding or infection, adverse reaction to anesthesia, difficulty swallowing (usually temporary), gas-bloat syndrome (difficulty belching or feeling full), and rarely, injury to surrounding organs.

The possibility of a hiatal hernia recurrence, or the need for revision surgery in the future, should also be discussed with the surgeon.

Are There Alternatives to Reflux Surgery?

Yes. Before recommending surgery, all patients are encouraged to try reflux surgery alternatives, which include:

• Dietary modifications (avoiding spicy, fatty, or acidic foods)
• Weight loss
• Elevating the head of the bed
• Antacid medications
• Behavioral changes (e.g., avoiding meals before bedtime)

For patients who have already had bariatric surgery or other abdominal operations, tailored alternatives may be required and should be discussed with a bariatric surgery specialist.

Choose USMD Hospital at Arlington for GERD Surgery

When GERD symptoms become severe or unmanageable, surgical intervention may offer long-term relief and prevent complications. At USMD Hospital at Arlington, patients benefit from:

• Minimally invasive surgery techniques
• Skilled surgeons on the medical staff
• Compassionate nursing care
• A dedicated surgical and post-op team

If you’re considering GERD surgery, USMD is here to support you every step of the way.