I read with great interest the recent article by Maret-Ouda et al: “Mortality from laparoscopic anti-reflux surgery in a nationwide cohort of the working-age population” that was recently published in the British Journal of Surgery. The purpose of this population-based analysis was to demonstrate the safety of minimally invasive Nissen fundoplication in Swedish hospitals. The authors analyzed patients that underwent the procedure from 1997 till 2013. 8947 patients were included with a median age of 48 years. Amazingly one death was directly related to surgery. In other words the mortality rate was 0.01% or 1 occurrence in 10000 patients. Along with a 0.4% 90-day reoperation rate, this study proves that Nissen surgery is a very safe procedure.
Furthermore, Nissen procedure is currently the only reliable and effective treatment for GERD. LINX™, Muse, TIF and Stretta procedures lack the reliability, durability and success rate provided by Nissen surgery. Antacid medications do not address the underlying problem. They simply mask the symptoms and put the patient at risk for a number of side effects including osteoporosis, magnesium deficiency, chronic renal failure, clostridium difficile colitis, altered gut microbiota, pneumonia, and dementia. Gastric acid secretion is part of normal physiology and blocking it for many years with powerful proton pump inhibitors, PPIs, does not seem as benign as we have assumed few years ago.
The problem with GERD treatment today is that many GERD patients with advanced disease are poorly managed with medications. PPI prescription has become a knee jerk reaction for any patient complaining of heartburn. The pharmaceutical industry has successfully reduced a complex medical problem that affects millions of people to a simple acid nuisance that can be eliminated with one OTC pill a day. This blind approach to GERD is unacceptable especially when effective and safe solutions are available. Patients with food regurgitation, chronic cough, hoarseness, nighttime symptoms and Barrett’s esophagus have advanced disease. Nissen procedure when performed by experienced surgeons who specialize in gastro-esophageal disorders is a reliable, effective, and safe solution. Many patients are unaware of more effective alternatives for treatment of acid reflux than medications. Houston Heartburn and Reflux Center is leading the charge in educating and helping acid reflux patients in Houston and all over Texas. If you or someone you know suffer from acid reflux do not hesitate to give us a call. We can help you.