A brief outline of current options for the surgical management of gastroesophageal reflux including the pros and cons of each.

1. Surgical Treatment of GERD
Which procedure is
best for you?
C. Daniel Smith, MD

2. Nissen Fundoplication
• Most common procedure performed
• Most often done laparoscopically
• Open approach may be
recommended for redo surgery or
complex hiatal hernia
• With an experienced surgeon,
90-95% of patients have good
control of typical GERD symptoms

3. Endolumenal Procedures
• Newer procedures performed through
the mouth and without any incisions in
abdomen
• Esophyx TIF and Stretta are only ones
currently available in U.S.
• Not an option in those with moderate to
large hiatal hernia or Barretts
esophagus
• With an experienced surgeon, 60-80%
of patients have control of typical
GERD symptoms

4. Linx Reflux System
• Recently approved by FDA
• Implanted laparoscopically around
end of esophagus
• Outpatient procedure
• Not an option in those with Barretts
or more than 3 cm hiatal hernia
• Only available at select centers

5. Nissen Fundoplication
Pros Cons
• Best studied and most • Most invasive procedure
common procedure requiring incisions in
performed abdomen
• Highest rate of success • Full recovery takes 3-4
weeks
(90-95%)
• Failure requires more
• Hiatal hernia is fixed complex redo surgery
• Outcome dependent on
• Best success with surgeon skill and
atypical GERD
experience
symptoms (80-90%)

6. Endolumenal Procedures
Pros Cons
• No incisions • New - unknown long term
success
• Less pain • Lower initial and early
success rates (60-80%)
• Faster recovery • Unknown results with
atypical GERD symptoms
• If fails, still candidate for • Not many surgeons with
laparoscopic Nissen experience
• Many insurance companies
do not cover

7. Linx Reflux System
Pros Cons
• Mechanically very similar • New - unknown long term
to native esophageal success
sphincter
• Not an option in Barretts or
more than 3 cm hiatal
• No need to alter diet hernia
after surgery
• After Linx implanted patient
can not have an MRI
• Minimal side effects
• Not widely available
• If fails, still candidate for
laparoscopic Nissen

8. Nissen Fundoplication
Details
• 60-90 minute procedure • Most are able to return to
work 2-4 weeks after
• 1 night stay in hospital surgery
• OK to shower the day after
• Risk of complication less surgery
than 1%
• OK to drive when no longer
• No heavy lifting for 4 using prescription pain
weeks after surgery medicine
• No special help needed at
• Liquid/soft food diet for 4 home
weeks after surgery

9. Endolumenal Procedures
Details
• 45-60 minute procedure • Most are able to return to
work 1-2 weeks after surgery
• 1 night stay in hospital • OK to shower the day after
surgery
• Risk of complication less
than 1% • OK to drive when no longer
using prescription pain
• No heavy lifting for 4 medicine
weeks after surgery • No special help needed at
home
• Liquid/soft food diet for 2
weeks after surgery

10. Linx Reflux System
Details
• 30-45 minute procedure • Most are able to return to
work 1-2 weeks after surgery
• No overnight stay • OK to shower the day after
surgery
• Less than 0.1% chance
of complication • OK to drive when no longer
using prescription pain
• Maintain regular diet medicine
immediately • No special help needed at
home

11. GERD Definitions
Typical GERD Symptoms
Heartburn
Regurgitation
Chest pain
Atypical GERD Symptoms
Cough
Laryngitis
Sore throat
Asthma