Other surgical treatments for GERD involve a procedure known as a fundoplication. The surgeon first tightens the opening in the diaphragm through which the esophagus enters the abdomen from the chest and then wraps part of the stomach partially or completely around the lower esophagus. If a hiatal hernia is present it is repaired as well. Traditionally fundoplications were performed through an incision in the abdomen. The Ohio State University Wexner Medical Center offers two far less invasive options: The laparoscopic Nissen Fundoplication and the EsophyX fundoplication, which is performed completely endoscopically, without external incisions.
Laparoscopic Nissen Using Single Multiport
This minimally invasive approach utilizes specialized video equipment and instruments that allow a surgeon to perform the fundoplication through several tiny incisions, most of which are less than a half-centimeter in size. Advantages include shorter hospitalization, less pain, fewer and smaller scars and a faster recovery. Laparoscopic fundoplication is safe and effective. However, in the presence of adhesions or variations in anatomy, this method may become dangerous and your surgeon may need to continue by making the traditional incision to safely complete the operation.
Incisionless Fundoplication (EsophyX)
Endoluminal tissue fusion, a relatively new type of fundoplication is performed using the EsophyX device. The EsophyX is passed into the stomach through the mouth with the guidance of an endoscope, or small flexible camera. Once the device is passed through the mouth and into the stomach, the surgeon places small plastic fasteners that fold the upper stomach unto itself and recreate the lower esophageal sphincter (LES). Re-creation of the LES stops the stomach acid from backing up into the esophagus, thus providing relief from the sensation of heartburn. This approach does not require any skin incisions and is therefore associated with fewer complications, less pain, and a faster recovery than other surgical options. While the procedure often requires an overnight hospital stay, it provides prompt improvement in symptoms, with a rapid recovery.
Complications, although rare, include bleeding and infection. Rare postoperative complications may involve difficulty with swallowing or the fundoplication slipping into the chest.