This irritates and inflames the esophagus, causing heartburn and eventually may damage the esophagus. A few patients may develop a condition in which there is a change in the type of cells in the lining of the lower esophagus, called Barrett’s esophagus. This is important because having this condition increases the risk of developing cancer of the esophagus.
“For patients suffering from frequent heartburn and dependent on anti-acid pills” said Dr. Stone, “this latest iteration of the TIF device serves as a long-term and safe alternative to the traditional surgical treatment – the Nissen fundoplication. The TIF procedure physically strengthens the valve at the bottom of the esophagus, as does the Nissen, but without surgery, and can eliminate the need for daily, indefinite use of anti-acid medications”. To some, the results of this follow-up study were misconstrued to imply that surgical therapy for GERD is ineffective. It is important to remember that this was an intention to treat analysis, and several of the patients who were originally randomized to surgery, never received this therapy and thus remained on antisecretory therapy. A symptom-based questionnaire was delivered to subjects both on and off medical therapy; compared to the medically treated patients, those who underwent antireflux surgery had only a slight increase in GERD-related symptoms off medication. Furthermore, they had significantly lower symptom scores off medication than their medically treated counterparts.
The implication is that surgery is effective in maintaining symptom control, and that many patients are placed on PPI therapy for non-GERD-related reasons. In about 10% of patients undergoing LARS, there will not be adequate intraabdominal esophageal length. Because the most common cause of failure after antireflux surgery is related to transdiaphragmatic herniation, at least 2.5 cm of tension-free intraabdominal esophagus must be present in order to perform a proper Nissen fundoplication.
With the LINX procedure, your doctor uses a laparoscope to put a ring of titanium beads around the outside of your lower esophagus. This strengthens the valve between the esophagus and stomach.
What to know about hiatal hernia surgery
WC A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. UCI Health esophageal disease experts now offer the LINX® Reflux Management System for people whose chronic gastroesophageal reflux disease (GERD) cannot be controlled medically, including daily use of medications such as proton pump inhibitors (PPI). Conflicting evidence also exists regarding the efficacy of antireflux surgery in case of Barrett’s esophagus.
From a therapeutic perspective, GERD results from reflux of gastric contents into esophagus due to mechanisms including TLESRs and hiatal hernia. For diagnosis, PPI test is advocated as a simple diagnostic tool to identify patients with GERD.
The stapler then engages the anterior and posterior gastric walls by applying suction. After staple application, the stapler is withdrawn and reloaded. The second staple row extends the sleeve distally creating an 8-cm long x 2-cm wide sleeve. A TOGA restrictor is then used to clamp and staple gastric folds together to reduce the sleeve outlet size (Figure 11). Results on the StomaphyX device are limited.
This conceptual framework focused on esophageal mucosal injury as the most significant clinical outcome in GERD. A recent large prospective cohort study confirms this concept, showing that true progression from mild to severe disease and even to BE has occurred over 2 years follow up .