GERD Surgery: Everything You Need to Know

What to expect when having this procedure

Surgical treatment of gastroesophageal reflux disease (GERD) prevents stomach fluid from entering the esophagus by surgically tightening the lower esophageal sphincter (LES). There are several different surgical methods used to treat GERD, with approaches that include endoscopy, minimally invasive laparoscopy, and open laparotomy. The procedure that's best for you depends on your medical condition and any structural issues affecting your digestive system.

What Is GERD Surgery?

Surgical operations that treat GERD are interventions that narrow the LES, which is a muscle located at the opening between the esophagus and the stomach. The surgery leaves an opening wide enough for food that's in the esophagus to enter the stomach while keeping the contents of the stomach from backing up into the esophagus.

There are a number of different surgeries used for treating GERD, involving strategies like suture placement or extending the upper portion of the stomach around the LES to tighten it.

GERD surgery allows your LES to open when you swallow, vomit, or burp. 

You could have GERD surgery with one of the following approaches:

  • Endoscopy, in which a camera-equipped surgical device is placed into the mouth to access the LES
  • A laparoscopic procedure, with the aid of surgical tools placed through small abdominal incisions, and the use of video assistance
  • An open laparotomy, with a large abdominal incision and direct visibility of the stomach and esophagus during surgery

You would need to stay in the hospital overnight after having an open laparotomy or a laparoscopic procedure and you might be able to go home on the same day as your surgery if you have an endoscopic GERD procedure.

These surgeries require pain control. For an open laparotomy or laparoscopic surgery, you would be medically put to sleep with general anesthesia. And you would have intravenous (IV, in a vein) sedation during an endoscopic GERD surgery.

Techniques used to narrow the LES in GERD surgery include:

Fundoplication: This is a common surgical treatment for GERD in which the upper part of the stomach is wrapped around the lower esophageal sphincter (LES). This surgery strengthens the sphincter to prevent acid reflux.

There are several types of fundoplication—including partial fundoplication, total fundoplication, anterior fundoplication, Nissen fundoplication, and Toupet fundoplication.

Fundoplication can be done with open laparotomy or with minimally invasive laparoscopy.

Plication: Usually done with endoscopy, a plication surgery involves the placement of sutures around the LES to tighten the muscle.

Radiofrequency: This is a procedure in which heat is applied to the LES to create lesions that narrow the opening. This procedure is typically done with endoscopy.

Magnetic sphincter augmentation: This technique involves wrapping a magnetic device (often described as the LINX system because that is the most commonly used brand) around the LES to hold it tight. A few different magnetic devices are available that can be placed around the LES with a minimally invasive procedure or endoscopically.

In addition to treatment for your GERD, you might also have surgical treatment of a stomach ulcer at the same time as your GERD surgery.

Contraindications

These procedures aren't right for everyone. A major medical problem can predispose you to surgical complications, potentially making GERD surgery more risky than beneficial. And severe esophageal disease might mean that GERD surgery could be ineffective or impossible.

  • General health issues: You could have difficulty recovering or a high risk of serious postoperative complications if you have issues like cardiovascular disease, a bleeding disorder, or severe respiratory disease.
  • Esophageal problems: If you've had previous esophageal surgery, achalasia (a motility problem of the esophagus), or esophageal varices (abnormal blood vessels in the esophagus), GERD surgery can be harmful to you.

Potential Risks

GERD surgery can cause complications related to general anesthesia or IV sedation. In addition, these procedures may cause immediate post-operative surgical complications or lasting esophageal problems.

Complications from GERD surgery may include:

  • Bleeding in the days after surgery—which may cause anemia, low blood pressure, or shock
  • An injury to the esophagus or stomach
  • Bowel obstruction due to inflammation or bleeding
  • A post-operative infection
  • Dysphagia (trouble swallowing), for weeks or months after surgery, or permanently

These complications can lead to a medical emergency within a week after surgery. You may need to have urgent medical or surgical treatment for the management of a postoperative complication after GERD surgery.

If you develop persistent dysphagia, you may need swallowing therapy to help you optimize your swallowing function.

And sometimes abdominal surgery leads to adhesions, which are post-surgical scars that can cause problems several years after surgery, ranging from cramping to life-threatening gastrointestinal obstruction.

Purpose of GERD Surgery

You might be a candidate for GERD surgery if you have gastric reflux that's not improving with medical treatment. This condition can cause heartburn. abdominal discomfort, hematemesis (vomiting blood), esophageal ulcers, Barrett's esophagus, and weight loss. GERD is also associated with an increased risk of esophageal cancer.

The effects of GERD occur due to the weakening of the LES, which allows stomach fluid, which is acidic, to backflow into the esophagus. This backflow irritates the inner lining of the esophagus, causing these symptoms.

GERD can occur without a known reason, but risk factors like smoking, obesity, and heavy alcohol intake increase the chances of developing the condition. Additionally, childhood congenital issues that lead to GERD may be treated with surgery.

lifestyle GERD treatments
Illustration by Jessica Olah, Verywell

Most of the time, lifestyle changes—like reducing alcohol intake and smoking cessation—can substantially reduce the effects of GERD. Antacids like Prilosec (omeprazole), Mylanta, Pepcid AC (famotidine), and Zantac (ranitidine) are all popular choices for managing GERD. Your doctor would likely recommend an over the counter or prescription formulation for you to take.

April 1, 2020 Update: The Food and Drug Administration (FDA) announced the recall of all medications containing the ingredient ranitidine, known by the brand name Zantac. The FDA also advised against taking OTC forms of ranitidine, and for patients taking prescription ranitidine to speak with their healthcare provider about other treatment options before stopping the medication. For more information, visit the FDA site.

H2 blockers like Pepcid, and proton pump inhibitors like Prilosec suppress gastric acid secretion, and these medications are commonly used to treat GERD. Each of these types of antacids has features that can help guide treatment planning.

Your doctor would recommend specific medication for you based on your symptom pattern and potential drug interactions with other medications that you take.

H2 Blockers PPIs
How Well They Work H2 blockers effectively block histamine 2, but no other stimuli that lead to acid production. Proton pump inhibitors address several stimuli that contribute to acid production and are considered more effective than H2 blockers.
How Soon They Work H2 blockers often work within an hour, becoming the most effective between one and three hours after you take them. PPIs work better when they're taken 30 minutes before your meal or on an empty stomach. When you wait to take them until right before or after you've eaten, your stomach has already released most of the acid the medicine is supposed to prevent.
How Long They Last H2 blockers may be effective for up to 12 hours. PPIs may last from 24 hours to three days.
Notable Side Effects A headache is the most common side effect of H2 blocker use. Ongoing research is looking at the association between PPIs, reduced calcium absorption, and an increased risk of bone fractures.

While non-surgical management is usually effective for treating GERD, you might still have intolerable symptoms even after using non-interventional methods of treatment.

Surgery might be a consideration for you if your doctor determines that tightening the opening between your esophagus and stomach would prevent stomach fluid from entering your esophagus and relieve your symptoms. This will involve diagnostic testing to evaluate the action of the LES muscle, as well as the pH of the fluid in your lower esophagus.

How to Prepare

Before your surgery, you will have a number of imaging tests that will be used in surgical planning. Pre-operative planning tests may include an abdominal computerized tomography (CT) scan, an abdominal ultrasound, or a diagnostic endoscopy.

You will also have standard pre-surgical testing, like a complete blood count (CBC) and a blood chemistry panel. Abnormalities like anemia or inadequate blood electrolyte levels would need to be corrected before your surgery.

Your anesthesia pre-operative testing will include an electrocardiogram (EKG) and a chest X-ray.

Because bleeding ulcers are common with GERD, you might need to have your own blood collected and stored about a week before your surgery in case you need a blood transfusion during your procedure.

Location

You would have your laparotomy or laparoscopic surgery in an operating room that's located in a hospital or surgical center. And you would have endoscopic surgery in an operating room or a procedural suite.

What to Wear

You can wear anything comfortable to your surgery appointment. You will wear a hospital gown during your surgery.

You should have something loose and comfortable to wear on your way home. And if you are having a laparotomy, there is a chance that you may go home with a surgical drain in your abdomen, so you should wear a loose shirt or a shirt that buttons in the front for access to the drain.

Food and Drink

You will have to abstain from food and drink after midnight the night before your surgery.

Medications

You will likely need to reduce or stop taking blood thinners and anti-inflammatory medications for several days prior to your surgery. In the days before your surgery, you may also need to adjust the dose of diabetes medication or steroids that you regularly take.

Your doctor will also give you specific instructions with respect to any medications that you take for the treatment of your GERD.

What to Bring

When you go to your surgery appointment, you will need to have your personal identification, insurance information, and a form of payment for any portion of the cost that you might be responsible for.

Additionally, you should make sure someone can drive you home when you are discharged to go home.

Pre-Op Lifestyle Changes

Before your surgery, you will need to avoid habits that worsen the effects of GERD so that any existing damage to the lower part of your esophagus will have a chance to heal. For example, you should avoid spicy or acidic food, cut down on alcohol, and stop smoking if you smoke.

What to Expect on the Day of Surgery

When you go in for your surgery appointment, you will need to register and sign a consent form. You may have same-day blood tests, including a CBC and chemistry panel. If these tests show that you have an acute problem, like anemia, you might still have your procedure, but your surgical team would be prepared in advance in case you need a blood transfusion.

Shortly before your procedure, you will go to a pre-operative area, where you will change into a hospital gown and have an IV placed in your hand or arm. You will have your temperature, pulse, blood pressure, and oxygen level checked.

Before the Surgery

Before your surgery, you will have your anesthesia started. And if you are having an incision, you will have your skin cleaned in the area of your incision.

Preparation for endoscopic GERD surgery: If you are having an endoscopy, you will receive anesthetic medication in your IV to make you drowsy and relaxed. And you will also have anesthetic medication sprayed in your mouth and throat to ease discomfort as the endoscope is advanced down into your esophagus and stomach.

Preparation for GERD surgery with an abdominal incision: If you are having a laparoscopic surgery or an open laparotomy, medication that induces general anesthesia will be injected in your IV for pain control. With general anesthesia, you won't be able to move or feel anything, and the medication will also put you to sleep. A breathing tube will be placed in your throat to assist you with breathing during your surgery.

If you will have a surgical incision, your abdomen will be covered with a surgical drape, and an area of skin will be exposed for your incision. Your skin will be cleansed with antiseptic solution before your surgery starts.

During the Surgery

The first step in your GERD surgery is access to your LES.

For an endoscopic procedure, your doctor will place an endoscope in your mouth and ask you to swallow. The endoscope will be advanced down to your LES. You won't be able to feel this process, and you might fall asleep. Your surgical team will be able to see the structures of your esophagus and stomach on a monitor.

If you are having one or more incisions, your surgeon will cut into the skin of your abdomen, and then into the peritoneal covering that encloses your gastrointestinal organs. With laparoscopic surgery, your surgeon will insert a camera to see the structures on a monitor, and with an open laparotomy, your surgeon will directly see the structures that need repair.

Once your surgeon has access to your LES, next steps may include:

  • Placing sutures near your LES to make it tighter
  • Application of radiofrequency heat with a laser to narrow your LES
  • Pulling up the top portion of your stomach over your LES and stitching it to tighten the opening
  • Placing a device outside your LES to narrow the opening

If you are also having an ulcer repair, this may be done at the same time. Issues such as excessive bleeding will be controlled during surgery. And a blood transfusion may be administered if necessary.

With major abdominal surgeries, inflammation and fluid may be problematic and can increase the risk of postoperative gastrointestinal obstruction. If this possibility is anticipated, your surgeon may place a surgical drain in your abdominal cavity, and extend the tube to the outside of your body so inflammatory fluid won't accumulate inside your body.

Once your laparotomy or laparoscopy is complete, you will have sutures to close any areas of peritoneum or skin that were cut for access, and your wound will be bandaged.

If you have had endoscopic surgery, the endoscope will be removed when your procedure is done. You won't need any additional sutures besides those that may have been placed to narrow the LES.

Your anesthesia medication will be stopped. If you have a breathing tube, it will be removed and your anesthesia team will ensure that you are breathing on your own before you leave the operating room to go to the recovery area.

After the Surgery

As you are recovering, your medical team will check on you. You might receive pain medication if you are having pain or discomfort. You will also have your pulse, blood pressure, and oxygen level monitored as you are waking up.

Your length of stay and degree of post-operative monitoring is guided by your type of surgery. For example, if you have had an endoscopic procedure with a few sutures placed near your LES, you might be able to go home within a few hours. If you have had an open procedure with a large incision, you will likely stay in the hospital for one or more days.

Keep in mind that if your surgery and recovery are going as planned, your post-operative stay and discharge will be the same as what you discussed with your doctor before your surgery.

When you are given the green light to go home, you will receive instructions about eating and drinking, physical activity, and wound and drain care (if you have a wound and drain). Additionally, you will have a follow-up appointment scheduled, and your doctor will tell you the signs of complications you need to look out for.

Recovery

After your surgery, you will have a phase of healing when you will need to slowly advance your diet. You might reach a point of resuming a normal diet after a week with a minor GERD surgery, or it may take several months if you have had a fundoplication with an ulcer repair.

Your post-operative recovery time should be shorter if you have had less extensive surgery or an endoscopic procedure and may take longer if you have had more extensive surgery or a large incision.

During your post-operative visits with your doctor, you might need sutures or a drain removed and wound care. Complications can occur with any type of procedure and tend to be more common if you have medical conditions or if you've had previous abdominal procedures. It's important that you get medical attention if you develop any signs of complications.

After your phase of recovery is over, you should notice an improvement in your symptoms.

Once you have passed the healing phase, you might still need to maintain dietary adjustments and lifestyle habits that don't exacerbate GERD. For example, your doctor may advise that you avoid smoking and drinking alcohol permanently so you won't have a recurrence.

Healing

As you are healing, your doctor will give you instructions about what you can eat. Generally, food and drink begin with clear fluids (like water and apple juice), and you will advance to more hearty fluids (like broth), then to soft food, and then to food that you need to chew. You might be able to advance your diet as tolerated if you have had an endoscopic procedure, or on a schedule specified by your surgeon if you've had an incision.

In addition to managing your diet, you will have to keep your wound and drain clean if you have them.

Signs of postoperative complications to look out for include:

  • Fever
  • Abdominal pain
  • Constipation
  • Diarrhea
  • Vomiting
  • Hematemesis
  • Blood in the stool
  • Lightheadedness, dizziness, or passing out

You should contact your doctor if you experience any of these issues.

Coping With Recovery

While you are recovering, you may be instructed to avoid physical exertion for several weeks. Your surgeon will give you specific instructions about advancing your activity. Be sure to follow instructions, and don't advance just because you feel ready—physical activity can cause sutures to break or may dislodge a surgical drain.

Long Term Care

You shouldn't need any specific long term medical care as a result of your surgery. However, if you have had certain types of magnetic devices placed, you might not be able to have a diagnostic MRI in the future.

Possible Future Surgeries

Generally, GERD surgery is a one-time procedure, without a need for any follow-up procedures. However, surgery may be necessary for the treatment of post-surgical obstruction caused by adhesions.

If you need another type of surgery for treatment of a different condition at some time in the future, be sure to tell your doctor about your GERD surgery, because your incisions and surgical restructuring can affect surgical planning for other abdominal surgeries.

Lifestyle Adjustments

If you are prone to GERD, you will likely be advised to avoid the foods and habits that exacerbate the condition. Not only will you need to stay away from harmful foods and drinks, but you will also be advised to maintain habits like eating slowly and staying upright for an hour or so after eating and drinking.

Additionally, you might need to take medication that is used to manage gastrointestinal irritation and ulcers. Your doctor will work with you on creating a plan to prevent a recurrence of GERD.

2:04

Avoid These Things If You Have GERD

A Word From Verywell

Most of the time, surgery is not part of the treatment plan for GERD. But refractory GERD with severe effects may require surgical intervention. After surgery, it's important to maintain lifestyle habits that help prevent a recurrence of GERD.

GERD Doctor Discussion Guide

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