I came across this article titled “Is Nissen Fundoplication the Best We Can Do?” and published in 2021 in the official newspaper of AGA (American Gastroenterology association). The author, a gastroenterologist, argues that “a safer standardized reversible surgical option” or “a less invasive endoscopic approach” have greater appeal than the standard Nissen fundoplication. He concludes that our current surgical options are “good but not perfect” and “we should not settle on the current state of GERD management”.
Interestingly, the author quotes a study by Spechler et al published in 2019 in the New England journal of Medicine that showed Nissen fundoplication was superior to medical management in patients who did not respond to proton pump inhibitors (PPIs). Thus, a mechanical solution to reflux disease, as the author describes Nissen fundoplication, may only be needed for some patients.
As an acid reflux surgeon and specialist in Houston, I find it difficult to try or even consider a novel or alternative procedure for acid reflux management besides Nissen fundoplication surgery. I have so far performed more than a 1000 consecutive Nissen fundoplications with 100% success rate and 0% complication rate. At Houston Heartburn and Reflux Center, our long-term hiatal hernia repair and Nissen fundoplication durability is very high. Equally, our patient satisfaction rate with surgery outcome, acid reflux symptom control and quality of life after surgery is very high.
At Houston Heartburn and Reflux Center, a properly performed Nissen fundoplication and hiatal hernia repair, is the perfect treatment for acid reflux disease. I simply cannot offer a better solution for GERD. For this reason, I do not recommend novel anti-reflux procedures especially when a foreign body must be implanted like RefluxStop™ or LINX™. Nissen fundoplication alters the geometry of the stomach to achieve a multifaceted physiologic effect that stops acid reflux.
Nissen fundoplication is indeed, more than a simple mechanical barrier to reflux. It is crucial for gastroenterologists in Houston to understand this concept to properly advise their GERD patients.