Reflux/Hiatal Hernia

About Gastroesophageal Reflux Disease (GERD)

GERD is a common cause of heartburn. The condition causes stomach acids to reflux (back-up) from the stomach into the esophagus. Symptoms include an intense, burning sensation in the area between your ribs and just below your neck, a chronic cough, sinus problems, or chest pain.  The feeling may radiate throughout the chest and into the throat and neck. Some adults experience these symptoms as often as twice a month. Other more intense symptoms include vomiting, difficulty swallowing, and chronic cough.

GERD Causes

Food travels from your mouth through your stomach through a tube called the esophagus. At the lower end of the esophagus is a ring-shaped muscle called the lower esophageal sphincter (LES). The LES functions as a one-way valve that allows food to pass to the stomach.

Normally, the LES closes immediately after swallowing to prevent backed-up stomach juices, which have high acidic content. In cases where the LES malfunctions, heartburn and esophageal damage may occur.
Some people are born with a naturally weak sphincter. Other causes are related to diet, medication, tight clothing, smoking, alcohol consumption, vigorous exercise, and changes in body position. A hiatal hernia (another common term for GERD) may be present without causing heartburn symptoms.

Treatment Options

GERD treatment requires multiple steps:

  • Lifestyle Modifications
    Dietary changes and over-the-counter antacids may reduce the frequency and severity of heartburn symptoms. Losing weight, eliminating smoking and alcohol consumption, modifying eating habits, and changing sleeping patterns may also be effective options.
  • Drug Therapy
    If lifestyle changes are unsuccessful, drug therapy may help. An antacid regimen will neutralize stomach acids and relieve symptoms. If over-the-counter medications are no effective, your doctor may prescribe a stronger drug. Your Houston surgeon will help you develop a highly personalized treatment plan.
  • Acid Reflux Therapy
    Surgery may be the best option for patients who do not respond well to lifestyle changes or medications or may not want to be on medications for the rest of their life.  Acid reflux surgery tends to have positive outcomes for GERD patients. Surgical options include an endoscopic/incisionless approach, laparoscopic approach and open surgery.   While lifestyle modifications and drug therapy may control the symptoms of reflux, surgery focus on controlling the cause of the reflux.

TIIF®: An INCISIONless GERD Procedure

Transoral Incisionless Fundoplication (TIF) treats GERD causes without requiring incisions. This procedure uses reconstruts the antireflux valve and restores the body’s natural protection against reflux. The procedure is performed within the GI tract with a device that is inserted through the patient’s mouth. The operation is completely incisionless, as it is performed transorally.  May view video here: 

Benefits of TIF:

  • No scarring or incisions
  • No cutting or dissecting
  • Minimal complications
  • No limitations of future treatment options
  • Can be revised if required
  • Rapid recovery

TIF patients report improved quality of life and alleviation of symptoms. Many patients no longer rely on acid reflux medication following surgery.

What TIF Patients Should Expect

You will be under general anesthesia and asleep during the procedure, which takes less than an hour. Typically, patients are able to go home the following the day. Patients are able to resume work and most normal activities within several days. Discomfort in the stomach, chest, nose and throat is common for 3-7 days after the procedure.

It is critical that patients comply with their surgeons’ recommendations to allow for proper repair and healing. Retching, vomiting or excessive physical activity within approximately 1 month following surgery may adversely affect repairs. There is a special 1 month post operative diet.

See the video below:

The Laparoscopic Acid Reflux Surgery

Laparoscopic acid reflux surgery (commonly referred to as Laparoscopic Nissen Fundoplication) involves strengthening the “valve” between the esophagus and the stomach by wrapping the upper portion of the stomach around the lowest portion of the esophagus.

In a laparoscopic procedure, surgeons use quarter to half-inch incisions to enter the abdomen using cannulas (narrow tube-like instruments). The laparoscope, which is connected to a tiny video camera, is inserted through the small incision, giving the surgeon an enlarged view of the patient’s internal organs on a television screen. The entire operation is performed within the abdomen.

What to Expect After Acid Reflux Surgery

  • Hostpital stay is general one night in the hospital
  • After surgery, patients are encouraged to engage in light exercise.
  • Post-operative pain tends to be mild; however, some patients will need prescription pain medications.
  • A special post operative diet will be given for the first month.
  • Within a short period of time, you will be able to resume regular activities such as showering, driving, walking up stairs, lifting, working, and engaging in sexual intercourse.
  • You will need to schedule a follow-up appointment within 2 weeks after your surgery.

Hiatal Hernias

Hiatal hernias cause part of the stomach to stick upward into the chest through a diaphragm opening. Hiatal hernias are common, especially among patients over 50 years old. Abdominal walls have natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain, aging, injury, previous surgical incisions, or congenital weaknesses from birth.

Common symptoms include chest pain, heartburn, swallowing difficulty, cough and trouble breathing at times. Pain and discomfort result from gastric acid reflux.