Surgery for acid reflux: Understanding the gold standard, and 2024 innovations

Gastro-oesophageal reflux disease (GORD), commonly referred to as acid reflux, occurs when stomach acid frequently flows back into the tube connecting the mouth and stomach (oesophagus). This backwash of acid can irritate the lining of the oesophagus, leading to uncomfortable symptoms like heartburn, regurgitation and difficulty swallowing. For those with severe acid reflux, surgery may be considered. This article from leading consultant laparoscopic (keyhole), upper gastrointestinal and bariatric (weight loss) surgeon Mr Sherif Awad explores the gold standard of surgical treatment for acid reflux and highlights innovations in 2024.

The gold standard: Laparoscopic Nissen fundoplication

Laparoscopic Nissen fundoplication is widely regarded as the gold standard surgical procedure for treating acid reflux. This minimally invasive technique involves wrapping the upper portion of the stomach (the fundus) around the lower oesophagus to reinforce the lower oesophageal sphincter (LES). The strengthened sphincter reduces or prevents acid from refluxing back into the oesophagus. By opting for a laparoscopic approach, surgeons can perform the procedure with only a few small incisions, reducing scarring, pain, and recovery time compared to traditional open surgery.

Patients who undergo laparoscopic Nissen fundoplication typically experience a significant reduction in acid reflux symptoms, and many are able to discontinue long-term use of medications such as proton pump inhibitors (PPIs). Recovery time is usually shorter, with many patients returning to normal activities within a couple of weeks. However, some individuals may experience side effects, such as difficulty swallowing (dysphagia) or bloating, which generally improve over time.

Innovations in 2024: The LINX system

One of the key innovations in acid reflux surgery as of 2024 is the increasing use of the LINX Reflux Management System. This is a less invasive option than fundoplication and has been gaining popularity due to its effectiveness and fewer complications. The LINX system involves implanting a small, flexible ring of magnetic beads around the lower oesophagus. The magnetic force helps the LES remain closed to prevent acid reflux while still allowing food to pass through when swallowing.

The LINX procedure has shown positive outcomes, including faster recovery times, fewer long-term complications, and reduced risk of issues like bloating and gas that are sometimes associated with fundoplication. The procedure is reversible and can be performed on patients with mild to moderate GORD who have not responded well to medical therapy.

Robotic-assisted surgery in acid reflux treatment

Robotic-assisted surgery has further revolutionised acid reflux treatment in recent years. Using robotic systems like the da Vinci surgical system, surgeons are able to perform procedures such as fundoplication with greater precision and control. These systems offer a 3D, high-definition view of the surgical area and allow for delicate movements that reduce the risk of complications.

Robotic-assisted surgeries for acid reflux are associated with quicker recovery times, fewer surgical complications, and improved outcomes. The enhanced dexterity provided by robotic instruments also allows surgeons to perform more complex cases with higher accuracy, which can be beneficial for patients with more severe or unusual cases of GORD.

Who is a candidate for acid reflux surgery?

Surgery for GORD is typically considered when other treatment options have been unsuccessful. This includes patients who:

• Do not respond well to medications like PPIs
• Have long-term GORD symptoms that affect their quality of life
• Suffer from complications of GORD such as oesophagitis or Barrett's oesophagus

Consulting with a specialist is essential for determining whether surgery is the right option, as well as deciding which procedure may be best suited to the individual's condition.

What's in store for the future of acid reflux surgery?

Surgery for acid reflux, particularly laparoscopic Nissen fundoplication, remains a highly effective treatment for patients who have not found relief through medication or lifestyle changes. Innovations like the LINX system and advancements in robotic-assisted surgery have provided new options for patients, offering less invasive procedures and quicker recoveries. As the landscape of acid reflux treatment continues to evolve, patients have more choices than ever to manage their symptoms and improve their quality of life.

If you're looking for expert surgery for acid reflux, arrange a consultation with Mr Awad via his Top Doctors profile.