Laparoscopic Treatment of GERD

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Laparoscopic Treatment of GERD
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Indications

• Failure of Medications
• Patient Preference
• Anatomical Defect
• Hiatal Hernias

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Who Requires Treatment?

• Symptomatic
• Reflux Regurgitation
• Chest pain SOB
• Bleeding
• Dysphagia (Difficult swallowing)
• Obstruction
• Aspiration with chronic pneumonia
• Hoarseness

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Preoperative Work-up

• Esophageal Manometry
• Bravo
• Upper Endoscopy
• Evaluation of Comorbidities
• Hypertension
• Diabetes
• Coronary Artery Disease

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Manometric Analysis of the LES

• Abnormal Values
• LES pressure lt 6mmHg
• Intraabdominal length lt 1cm
• Total LES length lt 2cm

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Bravo

• 24-48 hour pH monitoring
• Performed endoscopically now
• Definitively diagnosis of reflux
• Concurrently, endoscopy excludes other entities
  such as ulcer disease and tumors

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Surgical Technique

• Key Components
• Reduce Hernia
• Increase Intraabdominal length of Esophagus
• Close Crural defect (Hernia)
• Perform Anti-reflux procedure
• Nissen Fundoplication (360 degree wrap)

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Laparoscopic Ports
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10
5
10
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Esophagus
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Repair of Esophageal Hiatal Defect
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Defect closed with sutures
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Anti-reflux valve or wrap
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Nissen 360 degree wrap
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POD 1
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Complications

• Intraoperative
• Bleeding
• Infection
• Perforation
• Injury to Adjacent Organs

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Complications

• Postoperative
• Dysphagia (Difficulty swallowing)
• Transient in 95 for up to 3-4 weeks
• Persistent in 5 for 6 weeks
• Prolonged for 2-3 for 8 weeks
• Treat with Dilatation
• Recurrence
• 5-10 over 10 year period