If lifestyle changes and medications aren’t enough to relieve GERD symptoms, surgery may be recommended. Understanding your options can help you work with a doctor to decide what’s best.
Acid reflux occurs when stomach acid flows backward into the esophagus. This causes heartburn and other symptoms. Chronic or severe acid reflux is known as gastroesophageal reflux disease (GERD).
You can often relieve mild or moderate symptoms with lifestyle changes, such as altering your diet and eating habits.
Over-the-counter (OTC) and prescription medications can also help with symptom relief. Medications used to treat GERD include:
Some people continue to experience symptoms despite making lifestyle changes and taking medications. For these people, surgery may be an option.
Surgery focuses on repairing or replacing the valve at the bottom of the esophagus that normally keeps acid from moving backward from the stomach. This valve is called the lower esophageal sphincter (LES). A weak or damaged LES is the cause of GERD.
Surgery for GERD is usually a last resort. It’ typically only considered after other approaches like lifestyle changes and medications such as H2 blockers and PPIs are tried first. If these approaches don’t provide relief, then the doctor will consider surgery.
Some people might also ask about surgery as a way to avoid taking long-term medications.
A doctor may recommend surgery if you have serious GERD complications. For example, stomach acid can cause inflammation of the esophagus. This may lead to bleeding or ulcers. Scars from tissue damage can then constrict the esophagus and make swallowing difficult.
There are several surgical options that may help relieve GERD symptoms and manage complications. Consider speaking with a doctor for guidance on the best approach to managing your condition.
If your GERD requires surgery, it’s important to discuss the cost of your surgery with the doctor and hospital. The costs vary greatly depending on factors such as your health insurance, the hospital, and the type of surgery.
Pros of surgery for GERD
- helps you avoid long-term medications
- can help address GERD-related complications
Cons of surgery for GERD
- can be costly, depending on your health insurance
- can require weeks of rest before you’re able to return to work, depending on the type of surgery
Fundoplication is the standard surgical treatment for GERD. It tightens and reinforces the LES. The upper part of the stomach is wrapped around the outside of the lower esophagus to strengthen the LES.
It can be performed as open surgery or as laparoscopic surgery. During an open surgery, the surgeon makes a long incision in your stomach to access the esophagus. A laparoscopic surgery involves several smaller incisions.
The laparoscopic procedure is more commonly used, as it’s less invasive.
Preparation for this surgery is typical of that for any surgical procedure. It may include:
- following a clear liquid diet a few days before surgery
- taking medication to cleanse your bowels the day before surgery
- avoiding food on the day of surgery
Consider asking the surgeon for specific preparation instructions, as they may differ due to your individual medical history.
This type of surgery generally has a very good rate of long-term success. According to a 2017 study on laparoscopic surgery, success rates may reach as high as 90% in the 5 years postsurgery. But some people still experience acid reflux after surgery and may still have to use medications to treat their symptoms.
This laparoscopic surgery uses a special device called a LINX, which is a ring of tiny magnetic titanium beads. When wrapped around the LES, the LINX device strengthens the sphincter.
Because the beads are magnetized, they move together to keep the opening between the stomach and esophagus closed. Food can still pass through normally.
Since this is a minimally invasive surgery, recovery time is usually considerably shorter than traditional surgery.
This is a relatively new procedure, but it has been very effective in relieving acid reflux disease. A small 2019 study found the procedure to be effective in 91.1% of people.
For some people, nonsurgical procedures that use endoscopy may be used to treat GERD. While doctors don’t use these procedures often, you may consider these options if you want to avoid surgery.
Transoral incisionless fundoplication (TIF)
Transoral incisionless fundoplication (TIF) is a less invasive version of open or laparoscopic fundoplication. This procedure doesn’t require incisions. It’s an endoscopic procedure where a doctor can go through your mouth and use a special TIF device to repair or recreate the LES.
This procedure can be used to repair a previous open or laparoscopic fundoplication.
The Stretta procedure is an endoscopic procedure that can be done to repair the LES. Radiofrequency energy is applied via an endoscope to heat the esophageal muscle. This causes it to thicken, which can help restore function to the LES.
This procedure shows success in relieving or even eliminating the symptoms of GERD. But it’s still a fairly new procedure, so long-term results are unknown. One small 2020 study found that, after 6 months, it was significantly better at reducing symptoms than PPIs alone.
Recovery is slightly different for each option, depending on whether the procedure is open, laparoscopic, or endoscopic.
Laparoscopic surgery has a quicker recovery time and less pain than open surgery. But it may not be appropriate for every person with GERD. The doctor and the surgeon can work together to help decide which is best for you.
Fundoplication surgery is the most common surgery used for GERD treatment. The laparoscopic fundoplication procedure may only require 1 day in the hospital. You’ll be able to return to your lifestyle as usual within 2 to 4 weeks.
The open technique requires a longer hospital stay for the procedure, and then you need about 6 weeks of recovery before you’re able to return to work.
Nonsurgical, endoscopic procedures are often done within a day and have shorter recovery times that surgical procedures.
Consider talking with a doctor to help you decide which option is best for you.
For more popular surgeries used to treat GERD, your outlook is very good. These procedures relieve or even eliminate the symptoms of most people with GERD.
Some of the newer or less common surgical procedures haven’t had enough studies yet to determine their long-term success.
While surgery is usually the last resort for treating GERD, it can also be considered for eliminating the need for long-term medications. You should consider all options before deciding on surgery, and you should also consider checking with your insurance to see what’s covered.
If you decide to pursue surgery, you can work with a doctor to decide which procedure will be most likely to help you. They’ll also be able to ensure that you’re a good candidate for the recommended procedure.