Acid reflux / Gastro-esophageal reflux disease (GERD) is defined as a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Symptoms are considered troublesome if they adversely affected an individual’s well being.
Indications for Surgery
1) Patients who have failed medical management (inadequate symptom control, severe regurgitation not controlled with acid suppression, or medication side effects)
2) Patients who opt for surgery despite successful medical management (due to quality of life considerations, lifelong need for medication intake, expense of medications, etc.)
3) When patients have complications of GERD (e.g., Barrett’s esophagus, peptic stricture)
4) Patients have extra-esophageal manifestations (asthma, hoarseness, cough, chest pain, aspiration)
Anti-reflux surgery (laparoscopic fundoplication) has been shown to be very effective at relieving symptoms with excellent patient satisfaction, in both short and long term studies. These excellent results even include patients with complicated GERD, such as those with large hiatal hernias, refractory esophagitis and peptic strictures.
When compared to medical therapy, surgical therapy has proven to be superior.
A randomized, multicenter trial, with 5-year follow-up, demonstrated that anti-reflux surgery is more effective than proton pump inhibition (PPI) in controlling gastro-esophageal reflux disease symptoms.