Anti-Reflux Surgery in Birmingham, AL

This is a disease entity in which Dr. Adam Harris, a board-certified general surgeon in Birmingham, is particularly well trained.  While at the Mayo Clinic, he trained under Dr. C. Dan Smith who is one of the nation’s leaders in reflux and esophageal surgery.  In this part of the country, some gastroenterologists can be reluctant to refer patients for anti-reflux surgery even though studies have showed high patient satisfaction with anti-reflux surgery.  However, if patients have significant hiatal hernia they are often referred for surgery.  The best study to quantify the size of a hiatal hernia is a barium esophagram or barium swallow.  If there is not a significant hiatal hernia and if reflux symptoms are well controlled by medications and the patient does not mind taking these medications, then surgery is often not necessary.  However, repair should be considered in a patient with a significant hiatal hernia even if the patient has minimal symptoms as long as the patient is a reasonable candidate for surgery (healthy enough to tolerate general anesthesia, laparoscopic surgery, and the small risk of potential complications).  Tests that are generally undertaken before anti-reflux surgery include upper endoscopy, barium esophagram, esophageal manometry, esophageal pH testing, and sometimes gastric emptying.

Traditional anti-reflux consists of hiatal hernia repair and a fundoplication.  A fundoplication is performed by wrapping the fundus of the stomach (this is the floppy part of the upper stomach) around the end of the esophagus in either a partial or full wrap around the esophagus. There is also a new device called LINX that can be used instead of a fundoplication.  Antireflux surgery usually requires a one night stay in the hospital and is almost always done laparoscopically.

Proton pump inhibitor medications are the first line treatment GERD.  These work by powerfully reducing the amount of acid the stomach produces.  However, they do nothing to stop stomach contents from refluxing into the esophagus where they can still cause symptoms even though they are less acidic.  Some studies have suggested that long-term use of proton pump inhibitors may have negative health consequences. The laparoscopic Nissen fundoplication is a well established procedure for the treatment of GERD that has been successfully employed since the early 1990s.  It involves wrapping part of the stomach around the end of the esophagus.  The side effects are usually temporary trouble swallowing and belching as well as sometimes bloating.  The LINX device has been in use for about 1o years and has less side effects than the Nissen. The device consists of a ring of magnetic beads that augment the lower esophageal sphincter.  Despite positive study results, most insurance companies have refused to pay for LINX so patients often have to pay for the device themselves or have a Nissen instead.

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if you are interested in learning how Dr. Adam Harris, a leading Birmingham Anti-Reflux Surgeon, could help you, contact us today. We look forward speaking with you.

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