What are the surgeries for GERD

There are two major ways to gain access to the abdomen: open operations and laparoscopic operations. In a classic operation, the surgeon uses a knife (scalpel) to make an incision and open the abdomen. Today, more surgeons are trained in laparoscopic surgery, which is a different technique that enables a surgeon to use a scope or camera to perform the surgery. This is different than an endoscope or endoscopy. For both open and laparoscopic surgery, the patient is brought to the operating room and put to sleep by the anesthesiologist. Laparoscopic surgery is done by making three to five small incisions (less that an inch long) around the abdomen and belly button. A wand-like camera is inserted through one of the incisions, and then the abdomen is inflated with gas so that the surgeon can have a view of all the organs on a television screen. The surgeon can then insert different long, thin tools through each of the other incisions to perform the operation.

Laparoscopic surgery is common today and is regularly used to remove gallbladders and do gastric bypass surgery for obesity and anti-reflux surgery. The benefits of doing laparoscopic versus open surgery are hospital stays are shorter, the surgical wounds are smaller, recovery is much quicker, and the risk of developing a hernia at the surgical site is lower.

Once inside the abdomen, anti-reflux surgery is roughly the same for both techniques. The most commonly performed anti-reflux procedure is called a

Surgical wrap

Esophagus

Stomach

Figure 14 Nissen Fundoplication. Source: Courtesy of Lev M. Khitin, MD.

Nissen fundoplication (see Figure 14). A Nissen procedure again can be done openly or laparoscopically and basically involves wrapping the top of the stomach all the way around the bottom of the esophagus to tighten the LES. There are several variations of this procedure; in one, the stomach is only partially wrapped around the bottom of the esophagus, and this is called a Toupet procedure. A Belsey Mark IV procedure is a partial wrap, but instead of going in through the abdomen, the surgeon goes in through the chest to get to the bottom of the esophagus. The end result of all of these procedures is to reinforce the lower esophageal sphincter, the barrier to reflux.

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