Gastroesophageal reflux is a common situation, which may happen occasionally to anyone. In certain people, this happens often and may cause very annoying symptoms, which need daily medication. A very relaxed esophageal opening of the diaphragm causes it with the coexistence or not of a smaller or larger diaphragmatocele. Most people manage their symptoms well.
There are though some young patients who don’t want to take medication and restrict the way of living for the rest of their life. There are patients whose main symptoms, like nocturnal cough and suffocation, pharyngitis, hoarseness, dysphagia, regurgitations etc, don’t subside on medication. Other patients have developed Barrett’s esophagus or stenosis. All these patients need an operation.
Barrett’s esophagus is the transformation of the internal layer to enteric type which may become cancer on rare occasions. There are procedures to destroy this abnormality, and these should always be followed by an antireflux operation.
The operation that predominates in the last few decades is Nissen fundoplication , the creation of an artificial valve using the gastric fundus at the junction of esophagus and stomach which resists stomach contents to reflux in the esophagus. The postoperative period is rather easy for the patient with the only difficulty being the need to eat mashed food for 30 – 45 days. Operation success exceeds 95%.
Endoscopic fundoplication has been used for some years, but it is a procedure that gives satisfactory results only in patients with mild reflux. On unsatisfactory result, an operation to solve the problem is feasible.