Johns Hopkins Heartburn Center is among few in the region to offer transoral incisionless fundoplication-a minimally invasive, endoscopic procedure offering faster recovery time and improved outcomes for certain patients. These are usually the first things your doctor will do.
GERD is a very common disorder with increasing prevalence. Excessive reflux of acidic gastric contents has a multitude of symptoms for the suffering patient including heartburn, regurgitation, cough, and dysphagia.
The device is also designed to record when a patient feels symptoms to determine if these symptoms correlate with reflux episodes. This test is conducted over a 24-hour period on an ambulatory patient who is off acid-suppression medications.
system delivers low power, low temperature radiofreÂquency (RF) energy to the lower esophageal sphincÂter (LES) muscle and gastric cardia. This energy remodels the tissue, resulting in improved barrier function and fewer random relaxations that cause reflux symptoms. According to Dr. Klapper, there isnâ€™t just one treatment approach to GERD thatâ€™s suitable for everyone. â€œAs a comprehensive center for the surgical management of reflux, we can offer several solutions if antacids have failed or are no longer effective. We tailor our approach to each individualâ€™s needs.â€ The major advantage TIF has over these other therapies is that itâ€™s incisionless and can be done as an outpatient procedure, he said.
It can lead to the development of Barrett’s epithelium, which confers a higher risk of esophageal adenocarcinoma. During the procedure, a small, flexible band of magnetic titanium beads is implanted around the esophagus laparoscopically. When in place, the band supports a weak lower esophageal sphincter (LES), the muscle that opens and closes to allow food to enter and stay in the stomach. The magnetic attraction between the beads is strong enough to resist the gastric pressures that result in reflux, but is weak enough to allow for swallowing, belching or vomiting. Fundoplication.
of patients. This represents strong evidence regarding the efficacy and durability of the laparoscopic approach.
- In addition, our surgeons are often able to revise or repair unsuccessful anti-reflux procedures performed at other facilities using a minimally invasive approach.
- Maintain a healthy weight.
- The LES is a ring of muscle that surrounds the junction of the esophagus and the stomach and acts as a valve.
- Antireflux surgery is contraindicated in patients who cannot tolerate general anesthesia or, in the case of the laparoscopic approach, a pneumoperitoneum.
- Fundoplication can be performed as an open surgery.
- Prescription drugs may be more effective in healing irritation of the esophagus and relieving symptoms.
The procedure is minimally invasive and does not permanently alter the anatomy of the GI tract. Its potential disadvantages are difficulty in securing the device with consequent migration and small bowel obstruction and erosion. The StomaphyX is a single-use device, designed to create large gastric tissue folds (Figure 10). The procedure is performed under direct visualization using an adult endoscope placed through the deviceâ€™s dedicated channel. The device is placed in the correct position, suction is applied, and tissue is drawn into the distal part of the device.
Since it does not require incisions, this can be a good option for people with GERD. If medications do not relieve your GERD, but you do not want more invasive surgery, this may be an option you prefer. Fundoplication can be performed as an open surgery. During an open surgery, the surgeon makes a long incision in your stomach to access the esophagus.
Following the principles of ARS, the TIF procedure repairs the anti-reflux barrier by reducing a hiatal hernia (â‰¤ 2 cm), and creating a valve 2 to 4 cm in length and greater than 270 degree circumferential wrap, thus restoring the dynamics of the angle of His. Gastroesophageal reflux disease (GERD) is defined as the back-flow of stomach contents into the esophagus causing undesirable symptoms and potentially resulting in esophageal damage. Laparoscopic antireflux surgery (also called Nissen fundoplication) is used in the treatment of GERD when medicines are not successful. Laparoscopic antireflux surgery is a minimally-invasive procedure that corrects gastroesophageal reflux by creating an effective valve mechanism at the bottom of the esophagus.
Morbidly obese persons who have GERD that is uncontrolled by medical therapy and who meet the criteria for antireflux surgery should talk to their doctor about the option of bariatric surgery. Upper Endoscopy – An upper endoscopy or EGD involves placing a small camera through the mouth and into the upper gastrointestinal tract allowing evaluation of the esophagus, stomach, and first part of the small intestine (duodenum). This is generally done as an outpatient procedure under mild to moderate sedation. The purpose of endoscopy is to evaluate for reflux-related damage, to assess the integrity of the LES, and to identify any alternative or coexisting disease processes that may be contributing to symptoms. Long-term exposure of the esophagus to gastric acid can cause damage such as erosion (esophageal ulcers), inflammation (esophagitis), scarring (esophageal stricture), and changes to the inner esophageal lining (Barrettâ€™s esophagus).
This technique mimics the effects of antireflux surgery by recreating the antireflux barrier, restoring the angle of Hiss and forming an one-way gastroesophageal valve. The Plicator procedure has been tried in several centers and has been shown to reduce GERD symptoms and medication use for at least 36 months following initial treatment [155, 157]. Moreover, this procedure is free of major complications and generally well tolerated .
Antacids, such as Mylanta, Rolaids and Tums, may provide quick relief. But antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or sometimes kidney problems.