Nissen Fundoplication for Acid Reflux treatment
Nissen fundoplication surgery, when properly performed, sets the bar quite high in terms of our expectations for new treatment modalities for acid reflux disease. Heartburn patients with objective evidence of acid reflux who undergo Nissen fundoplication and hiatal hernia surgery at Houston heartburn and Reflux Center are happy patients. They enjoy complete acid reflux symptom resolution, for many years after surgery and at a very low complication rate. Stretta, EndoStim, LINX, and Esophyx are neither safer nor more effective than Nissen fundoplication. Most importantly, none of these devices and modalities address the multifactorial pathophysiology of acid reflux disease like Nissen fundoplication and hiatal hernia repair. Last but not least, a prospective randomized trial comparing a novel acid reflux treatment modality to Nissen fundoplication
Consequently, one cannot but wonder about the indications to perform Linx, TIF or Stretta procedure. Endoscopic acid reflux procedures are scarless and therefore more attractive to patients. There are, however, no high-quality studies that demonstrate better or equivalent efficacy, durability and safety when compared to Nissen fundoplication. Stretta for example is an endoscopic procedure for treatment of acid reflux disease approved by the FDA in 2000. The device is developed with the purpose of increasing the competency of the lower esophageal sphincter. In reality, all it does is increased scarring around that area. Prospective randomized studies showed no improvement in the lower esophageal sphincter function and no decrease in acid reflux. Potential serious complications associated with Stretta include gastroparesis and necrotizing pancreatitis. A number of acid reflux specialist still recommend Stretta procedure. They claim that Stretta doesn’t burn any bridge and if doesn’t work a Nissen fundoplication can still be performed.
At Houston Heartburn and Reflux Center, we recommend the best to our patients. The best modality for acid reflux treatment, today, is a properly performed Nissen fundoplication. If an acid reflux surgeon does not know how to perform a proper Nissen fundoplication, would LINX, TIF and Stretta be indicated? I will answer this question in next week blog.