Surgical Associates
of Ithaca, P.C.

Cayuga Professional Center
1301 Trumansburg Rd
Ithaca, New York 14850
(607) 273-3161

Band-Aid Surgery Can Cure Painful, Chronic Heartburn

by David A. Schwed, M.D.

Perhaps one-third of the population suffers from heartburn or hiatal hernia. While a majority gains relief through medical treatment, 5 to 10 percent may not respond. The disease still has a significant impact on their lives and they live in chronic discomfort. These people may be better served by curative surgery.

What causes heartburn?
The esophagus is the swallowing tube that connects the mouth to the stomach. At the lower end of the esophagus, a valve (called the lower esophageal sphincter or LES) controls the passage of food into the stomach. When the valve is working effectively, it opens so food can move into the stomach and then closes. When the valve is weak and does not close properly, stomach acid washes up into the esophagus causing a severe burning sensation. The medical name for this condition we know as heartburn is gastro-esophageal reflux disease (GERD).

What is hiatal hernia?
Just before the esophagus reaches the abdomen, it passes through a gap in the diaphragm called the hiatus. A hiatal hernia occurs when the gap or hiatus expands and the stomach protrudes through the gap or hiatus expands and the stomach protrudes through the gap up into the chest. Some people with heartburn also suffer from hiatal hernia.

How is GERD treated?
Medical management of symptoms works for the majority of patients. Physicians recommend that patients lose weight, elevate the head of the bed to reduce acid reflux and avoid foods that aggravate their symptoms. Quitting smoking, limiting coffee and eating smaller meals helps. Antacids after eating and before bedtime are prescribed as well. If painful symptoms persist, the physician may prescribe “H2 blockers” like Tagamet or Zantac, or “acid inhibitors” like Protonix or Nexium. If none of these approaches provides adequate relief, surgery may be recommended.

What happens during surgery?
This operation, called Nissen Fundoplication, is performed in the hospital using a laparoscope. Commonly referred to as “band-aid” surgery, the procedure is performed through a few incisions, each ½ inch in size. The lower esophageal sphincter is strengthened by folding a small portion of the stomach around the sphincter to increase the sphincter’s competency.

What are the results?
Laparoscopic Nissen Fundoplication is highly effective at eliminating the need for lifelong medications. Following surgery, patients can resueme a normal lifestyle, including the consumption of spicy foods. Most patients go home the day after surgery and are back to work in a week. Pain and scarring are minimazed because the surgery is performed through a few tine incisions, rather than a large abdominal incision.
Because Laparoscopic Nissen Fundoplication is such a safe procedure, it is being performed more and more often to correct GERD. Moreover, this procedure is easier on patients than the conventional surgery so they are choosing to have it done earlier in the disease process. This protects them from the damage caused by years of acid spilling into the esophagus.