The benefits are control or elimination of GERD, regurgitation, and aspiration. Another benefit is the ability to stop taking or to reduce GERD medications possibly for life. Finally, surgery can lead to improvement in asthma or extraesophageal GERD symptoms.
Any operation and anesthesia is risky. A specific risk associated with anti-reflux surgery is resulting difficulty swallowing with food getting stuck. This can require endoscopy and dilation for treatment. Normally, you can belch and relieve excess gas; but patients who have had anti-reflux surgery can have abdominal bloating because they cannot belch. Diarrhea is not uncommon because the surgery may speed up stomach emptying. The ability to vomit can be impaired or it can become impossible in patients who have had an anti-reflux procedure. Hernias can develop within the abdomen or at the surgical wound site that can require repeat operation. Studies have demonstrated that more than 50% of patients who have had a Nissen procedure develop new and different symptoms postoperatively . Historically, open Nissen fundoplications had a fixed lifespan, and after about 7 years the stitches holding the stomach together around the esophagus fell apart, requiring repeat operation. On rare occasions, the whole wrap, which should be in the abdomen, can herniate (move) into the chest and require another operation.
A French study by Pessaux and colleagues, published in 2005 in the Archives of Surgery, followed for 5 or more years 1340 patients who had anti-reflux surgery. The study found that about 5% of patients had severe difficulty with swallowing, more than 7% had gas and bloating, more than 5% of patients required another operation, and 10% of patients required a proton pump inhibitor to control GERD symptoms. Interestingly, in this study nearly 2700 patients had surgery, but less than half were available for study. This suggests that the patients who were happy with their surgery outcomes participated in the study, which skews the results to look better than they actually are. Also, the authors of the study were the surgeons who did the surgery.
This points out the problem of looking at the antireflux surgery literature: most of it is written by surgeons who perform the operation, and it may be biased.
By Mortin - Copyright 2010
Last modification 24/04/2010
What are the Long-term Benefits and Risks of Acid Reflux Surgery? References