GERD: surgical treatment, description of methods of operations
Surgical treatment of GERD
Surgery is not the most extreme measure in the treatment of diseases of the digestive system. Often, it is a forced necessity, which is caused by many factors and indicators. And in the case of GERD, surgical treatment may be the main acceptable method of getting rid of pronounced chest pain and unbearable heartburn.
The decision on the surgery involves not only surgeons, but also internists and gastroenterologists, so any interference seriously balanced and always justified.
Types of operations in the treatment of GERD
Conventionally, surgical operations performed for the treatment of gastroesophageal reflux disease can be divided into two types.
- Surgery to treat the immediate causes of GERD.
- Elimination of consequences of or complications that have developed as a result of improper or untimely treatment.
The first kind of surgical treatment is carried out in a planned manner. The second type is often urgently, for example, the result of the opened the massive bleeding.
Indications for surgery for GERD
In some cases it is necessary to use it for surgical treatment.
- About the operations in question, when prolonged courses of drugs at maximum doses do not bring relief to the person suffering from this unpleasant disease.
- Aggressive lightning for GERD is also an indication for surgery. When the number of refluxes (casts acid or other stomach contents into the esophagus) daily exceeds more than 50, pain not stopped by medications, heartburn worried constantly, regardless of the meal, and when examination revealed esophagitis 5 degrees.
- A hiatal hernia of the diaphragm in combination with gastroesophageal reflux disease, also corrected surgically.
- Any complication is an indication for surgery: esophageal bleeding, Barrett’s esophagus, multiple ulcers and a significant narrowing of the organ, strictures.
- The relative indication for surgical treatment is a lack of money for long-term therapy. The treatment can last from two to three months, as is the case with esophagitis grade 3 and 4 severity, to a year or more, which is typical for Barrett’s esophagus. It is necessary to constantly use blockers of the proton pump, antacids courses (alginates) and prokinetics. And this is the best, sometimes the therapy combines the drugs in five groups and more. Not always the person’s budget can withstand such expenses.
- Severe allergic reactions to all drugs against GERD.
Surgical treatment is not always shown, there are cases in which it is applied makes no sense.
- In the presence of severe comorbidity: a heart rhythm disorder, kidney failure.
- His advanced age.
Methods of surgical treatment of GERD
One of the leading causes of the disease is the failure of the lower esophageal sphincter (it’s the muscle that does not pass food back from the stomach up). As a result, the gastric content continually enters the esophagus it refluxes that is felt in the form of heartburn and chest pains.
To remove these symptoms you need to thoroughly strengthen the muscle. There are several ways.
- One of the most common operations when GERD is fundoplication. The essence of this method of strengthening the sphincter is the suturing of the stomach to the esophagus (in the process of the operation stomach tighten up, they envelop the lower part of the tube of the esophagus). There are several types of such operations, which are called by name of the author who invented it (the most commonly used today, Nissen fundoplication).
- Another option is endoscopic correction of the sphincter (via the probe).
On that not only dared the surgeons for the correction of sphincter — there were attempts to suture the muscle with the aim of strengthening, the doctors even tried to introduce the silicone in the sphincter. All this is further accompanied by physiotherapeutic influence on the esophagus from the inside. But while this treatment has not brought visible results.
The dependence of the method, the operations from complications of GERD
The type and method of surgical treatment depends on the obtained complications of gastroesophageal reflux disease.
- Multiple ulcers long treat alternately in hospital and on an outpatient basis. If they do not heal and begin to bleed profusely as the result of a vascular lesion, such defect is sutured.
- Strictures (narrowing of the esophagus as a result of replacement with scar tissue) are trying to eliminate, because the lumen of the organ is significantly narrowed. To do this, they «cut», restoring the natural permeability of the esophagus.
- Barrett’s esophagus treated in two ways: laser photocoagulation (cauterization) sites substituted epithelium or complete surgical removal of the affected part of the esophagus.
Do not be afraid of surgical treatment in the case of GERD. This is a simple surgery with small incisions and minimal impact. They help people suffering from this unpleasant illness to experience the freedom from the forced continuous use of drugs. Any treatment it is important to carefully weigh.