This is a difficult question to answer, and the decision really is yours. The real issue is how bad your acid reflux and/or regurgitation is. Does medication control your symptoms adequately? How difficult or costly is it to take a medication once or twice a day? Is your acid reflux making your life difficult or miserable? If the answer to these questions is yes, then surgery may be an option.
The goal of anti-reflux surgery is to strengthen the lower esophageal sphincter, which is the barrier to reflux of material from the stomach into the esophagus. First, there are risks to surgery and anesthesia— are you a surgical candidate? Because acid reflux can be treated with medication, this is elective surgery, meaning that the surgery is being done to improve your lifestyle, not for a life-and-death condition. Patients with heart disease such as angina, recent heart attacks, and congestive heart failure are at increased risk in surgery and under anesthesia. Those with severe lung disease such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, or those on home oxygen are also at great risk. Obesity additionally increases the risks and makes wound healing and postoperative infections more likely. So, if you have any of the preceding conditions, surgery may not be right for you.
Prior to surgery an evaluation of the esophagus needs to be done. Before you are referred to a surgeon, have an endoscopy done to see if you have Barrett’s esophagus or esophagitis. All patients are trialed on a proton pump inhibitor to see if preventing acid entering the esophagus makes their acid reflux symptoms better. Because not all burning chest discomfort is heartburn and because it is important to make sure the symptoms you are experiencing are truly acid reflux, you’ll need a pH study to determine whether the pain or discomfort you have correlates to the presence of acid in your esophagus. You should also have a motility study to see whether your lower esophageal sphincter is weak or relaxes inappropriately and whether the rest of the esophagus pumps normally. Some diseases weaken both the LES and the muscles in the body of the esophagus that push food down to the stomach when you swallow. These are diagnosed with a motility study. If weakened LES and esophageal muscles are present and not found prior to surgery, you might not be able to swallow after surgery.
Any surgery carries risks. Patients can experience heart or lung problems from the stress of the operation or anesthesia. Bleeding or infections can complicate or prolong hospital stays. Patients can develop blood clots from the operation or from bed rest, and the clots can be life-threatening. Damage can be done to the stomach or esophagus during surgery. Not too uncommonly, surgery might make the lower esophageal sphincter too tight, and then patients have difficulty swallowing and need endoscopy and dilation. Some patients may require antacid medication again after surgery.
Because of all of these issues and risks of surgery, we do not recommend anti-reflux surgery to many patients. It is usually reserved for young, healthy people that do not want to take lifelong medications or have severe, poorly controlled acid reflux symptoms on medications.
By Mortin - Copyright 2009
Last modification 31/12/2009
Should I have Surgery for Acid Reflux? References