Surgery Can Resolve Reflux Disease

Q:  With more and more people using drugs to control their gastroesophageal reflux disease (GERD), I would like you to comment on the success of the Nissen fundoplication surgery to control GERD. What is the success rate? Is this a permanent cure? Who would be a good candidate for the surgery?

A:  GERD is a chronic disease that occurs when stomach acid and bile from the intestine "reflux" or move back up into the esophagus more than normal, leading to symptoms such as heartburn, regurgitation (sour or bitter fluid coming up into the mouth), chronic cough and/or trouble swallowing. GERD can be treated with antacid medicines that shut off the stomach acid or surgery to stop the acid and bile from getting into the esophagus.

The Nissen fundoplication is a surgical procedure that basically creates a new valve at the lower end of the esophagus by wrapping the top of the stomach around the esophagus to stop GERD. It was developed and named after Rudolf Nissen of Germany in 1936, so it has a long track record of being a safe, effective and long-lasting alternative to lifelong medical therapy.

Dennis Blom, assistant professor of gastrointestinal surgery at the Medical College of Wisconsin, performs this same operation through several small incisions using a camera and special instruments (laparoscopic Nissen fundoplication). This allows patients to go home after one or two days in the hospital with much less pain. One of the medical students working with me last month had the operation on a Thursday and was back at the hospital seeing patients on Monday!

More than 90% of patients who have been followed up for about three years after a laparoscopic Nissen have relief of symptoms. Studies of the Nissen fundoplication done through a larger incision have shown similar results, with approximately 90% of patients having relief of GERD for as long as 10 years.

The best candidates for a laparoscopic Nissen are people with the typical symptoms of GERD (heartburn and regurgitation), objective proof of abnormal esophageal acid exposure by pH testing and those who require chronic antacid medicines for symptom relief. This may be particularly true in patients younger than 50 who would rather not take lifelong medication and/or those at risk for disease progression despite medical therapy.

For more information on Nissen fundoplication surgery, see the following Dr. Becky article: Barrett's Esophagus and Nissen Surgery

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.