Specialties

Acid Reflux (GERD) & Hiatal Hernia Surgery

Surgery for Gastroesophageal Acid Reflux Disease

Gastroesophageal reflux disease (GERD) is caused by acid from the stomach flowing back up into the esophagus (the foodpipe) through a weakened one-way valve near the top of the stomach called the lower esophageal sphincter (LES). This causes inflammation (irritation) of the esophagus and typically leads to pain, pressure, and a burning sensation in the middle of the chest. Other symptoms may include a bitter or sour taste in the back of the mouth, frequent belching, pain in the upper abdomen, chronic cough, hoarseness.

Initial treatment includes dietary changes, lifestyle changes and medication. In the majority of people, these treatments are successful. However, if the symptoms persist despite the treatments or if the growth of abnormal cells in the lining of the esophagus is detected (a condition known as Barrett’s esophagus), people may be referred to a surgeon to discuss anti-reflux surgery.

Anti-reflux surgery is usually done through multiple small incisions and is called a laparoscopic fundoplication. This involves wrapping the upper part of the stomach around the weakened one-way valve (LES) to strengthen it and prevent acid reflux and GERD. This surgery has a high success rate as long as after surgery instructions are followed.

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Hiatal Hernia Surgery

A hiatal hernia is a condition in which part of the stomach bulges up into the chest through a hole in the diaphragm muscle called a hiatus. The diaphragm normally has a small hole to allow the esophagus (food pipe) to pass through on its way to connect to the stomach. A weakening of the hiatus causes it to enlarge which allows part of the stomach to go up into the chest.

Most hiatal hernias never cause problems. When symptoms do occur, they are similar to those of gastroesophageal reflux disease-heartburn, bitter or sour taste in the back of the mouth, bloating, belching, pain in the upper abdomen or lower chest. Some people may also have nausea and vomiting.

A hiatal hernia can be diagnosed by x-ray or endoscopy. Many people are treated successfully with dietary changes, lifestyle changes and medication. If these fail to control the symptoms, surgery may be recommended.

Surgery usually is performed by way of laparoscopy (multiple small incisions) and involves repairing the weakened hiatus and often performing an anti-reflux procedure. People typically do well as long as they follow the after surgery instructions and make some minor lifestyle changes.

Surgery for Achalasia

Achalasia is a rare disease of the esophagus (food pipe) in which the one-way valve at the junction between the esophagus and stomach (called the LES) stops relaxing when food tries to get through. At first, people have difficulty swallowing solids and often regurgitate them. As time passes, people then start having difficulty swallowing liquids.

Achalasia is usually diagnosed using a combination of a specialized x-ray, upper endoscopy, and a test of the function of the esophagus called manometry.

There are three well-known treatments for achalasia. First, injection of Botox into the LES which leads to temporary relaxation, but does not provide long-term relief. Second, dilating (widening) the LES using endoscopy which may provide long-term relief in some. Third, is cutting part of the lower esophagus muscle which is called a Heller myotomy. This can usually be done laparoscopically (multiple small incisions). This procedure has the best long-term result.

The goal of the operation is to make the situation significantly better. There are also some simple lifestyle changes after surgery.

Our esophageal surgery patients come to us from Kernersville, Winston-Salem, Burlington, High Point, Greensboro and adjacent locations.