GERD surgery in the form of laparoscopic hiatal hernia repair and Nissen fundoplication is the most reliable treatment for severe acid reflux disease, but only in the hands of the expert. Expert acid reflux surgeons at Houston heartburn and reflux Center dedicate their practice to the diagnosis and treatment of acid reflux disease. The end result is high patient satisfaction; the hallmark of a center of excellence for heartburn management.
Heartburn and acid reflux surgery requires advanced skills, and deep knowledge of GERD pathophysiology. Hiatal hernia repair and Nissen fundoplication are considered physiologic procedures. The stomach is manipulated to achieve a desired outcome: stop reflux. The surgeon does not resect or bypass the stomach. Rather, the stomach is gently plicated without torsion or tension around the lower esophageal sphincter to re-establish the anti-reflux barrier. The components of this newly created anti-reflux barrier are many. A common mistake is to assume that the fundoplication works as a high-pressure area around the lower esophageal sphincter. The fundoplication is not a stricture and should not mechanically restrict the distal esophagus. Indeed, we perform a short and floppy fundoplication to create the least amount of resistance to esophageal emptying. The end result is high acid reflux control and very low postoperative dysphagia rate.
A competent acid reflux surgeon understands these nuances not only in the operating room but also during acid reflux work up prior to fundoplication surgery. For this reason, at Houston heartburn and reflux center, workup, diagnosis and treatment are all concentrated in one place under the supervision of one expert acid reflux specialist. Acid reflux workup and patient selection are important determinants of acid reflux treatment outcome. One cannot expect excellent Nissen fundoplication outcomes if heartburn diagnosis and treatment are separated.
In summary, GERD management is best performed in dedicated centers for heartburn and acid reflux diagnosis and treatment. Nissen fundoplication and hiatal hernia procedure is an excellent solution for heartburn but only in the hands of competent acid reflux specialists.