Simple Surgery for GERD
Tue, January 30, 2007 at 02:37AM Some years ago, severe gastroesophageal reflux disease (GERD) necessitated surgery, which meant approaching the problem through the abdomen, either by an incision several inches long, or, later, by laparoscopy, in which one or two very small incisions were used to insert operative instruments guided using a miniscule camera. More recently, endoscopic surgery has become popular. This involves manipulation through an esophagoscope – a tube passed down the gullet to the opening into the stomach.
In all surgeries, the basic procedure is called fundoplication, which entails creating a ‘collar’ of muscle to strengthen the lower esophageal sphincter muscle. Endoscopic fundoplication is a procedure that achieves the same result, without opening the abdominal cavity. It was first described in 2002, and has been done frequently since then. But doubts have existed about its effectiveness and safety. Now there’s a publication in Surgical Endoscopy that just about lays those doubts to rest.
The Beth Israel Deaconess researchers in Boston report on the health of 29 of their original 64 patients who had the procedure over 3 years ago. Over half of them had continued complete relief of symptoms, although half of these (i.e. 16 patients) still occasionally used proton pump inhibitor drugs (e.g. Nexium ®). All adverse events reported occurred immediately after surgery, and there were no adverse effects during the 3-year follow-up period.
It’s disappointing that only half the original patients were available after 3 years. What happened to the others? Did they relapse – need further surgery or intensive medication? This rather detracts from the value of the results of the study . . .
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