Esophageal Reflux is a common condition causing heartburn, which can often be controlled with medications. However, when symptoms (coughing, feeling of choking, refluxing when sitting up) are severe or symptoms don’t respond to medications and lifestyle modification, surgery should be considered.
Factors that contribute to reflux are an esophagus that does not reach 2 to 4cm into the abdomen; where positive pressures prevent reflux or a hiatal hernia; and where the opening of the esophagus passes into the abdomen is lax and the top of the stomach goes up into the chest. Hiatal hernias, when large, can also cause chest pain that mimics cardiac pain.
Laparoscopic Nissen Fundoplication is the surgery for reflux and hiatal hernia. The aim of the surgery is to bring the lower end of the esophagus 2-4cm down into the abdomen, where the positive pressure helps:
- Keep the esophagus closed to reflux
- Close the opening of the diaphragm around the esophagus, preventing herniation of the stomach
- Create a valve that prevents reflux by wrapping the upper stomach around the lower end of the esophagus.