Surgical Treatment of Reflux – Why

The indications for considering a surgical therapy are actually very easy to define. One easy indication is the size or presence of an hiatal hernia. A hiatal hernia is a large gap in the diaphragm that allows a portion of your stomach to move from the positive pressure area of the abdomen into the negative pressure area of the chest, causing retention of the stomach contents there. In fact, it facilitates the movement of stomach contents into the chest area, where it’s much easier to result in serious complications of reflux.

The repair of the hiatal hernia becomes very important, and there are two methods to fix approach an hiatal hernia. One is known as the Hill procedure, in which case they will pull the stomach back down under the diaphragm, close the diaphragm with a mesh reinforcement, and then stitch the stomach to the tissues in the back of the abdomen, so it will no longer be able to go back up into the chest. That’s the simplest of the procedures.

More commonly done, however, is a procedure known as the Nissen fundoplication, where they will perform the same elements as the Hill procedure but, in addition, they will take the upper portion of the stomach, which is known as the fundus, and wrap that in a circular fashion around the esophagus.  This essentially forms an external barrier that will impede gastric contents from coming back up into the esophagus.

These procedures have been done for decades and have a very high safety margin. In fact, they’re some of the safest surgical procedures that can be done, and some of the most effective, especially for those patients who suffer from hiatal hernias.