A minimally invasive procedure is an alternative to traditional, or what is known as “open” surgery, in which a large incision must be made to expose the area of the body to be operated on. The minimally invasive procedure eliminates the need for this long incision.

Small incisions are made to accommodate small tubes called trocars. These create a passageway for special surgical instruments and a laparoscope. A laparoscope is a fiber-optic instrument that is inserted in the abdominal wall and is used to visually examine the interior of what is known as the peritoneal cavity. This device is used to transmit images from within the body to a video monitor, allowing the surgeon to see the operative area on the screen.

The minimally invasive antireflux procedure improves the natural barrier between the stomach and the esophagus. In this procedure, the surgeon wraps the gastric fundus, a part of the stomach, around the lower esophagus. This prevents the flow of acids from the stomach into the esophagus.

Since the small incisions used in minimally invasive procedures do not cut across large tissue areas, scarring tends to be significantly reduced. Patients who are appropriate candidates for a minimally invasive procedure usually stay in the hospital from one to three days, instead of the five to seven days required for open surgery. In many cases, recovery time can be as little as one to two weeks, as compared with four to six weeks for open surgery.

Reflux can recur following surgery, but recurrence is rare. The rate of recurrence varies between 4 and 15 percent and largely depends on how extensive the disease was before surgery and if the esophagus was damaged. Recurrence can happen at any time, up to 20 years after the surgery, but it is most common in the first one to two years after surgery. If reflux does recur, the surgery can be repeated, with success rates of around 90 percent.

Recurrence of reflux, or of a hiatal hernia, should be uncommon. It is more common in patients with a very large hernia, strictures, and obesity.

Minimally invasive surgery uses special instruments—a fiber-optic camera, light source, and video monitor—to view the anatomy for the procedure. These special instruments allow the procedure to be done less invasively with a few small incisions. Because minimally invasive surgery requires only a few small incisions, scarring tends to be greatly reduced or very minimal, hospital stays tend to be shorter, and recovery tends to be faster than with traditional surgery.

After the surgery, patients can expect some pain in their abdomen where small incisions were made, but this is usually tolerable and goes away in several days.

Trouble swallowing is also a potential side effect and can vary from no problems at all to the ability to swallow only liquids. This can persist from several days up to several months, but usually gets better with time. Patients are able to begin a liquid diet when they are awake and alert, but should avoid cold liquids or ice, which may cause some esophageal spasms.

If patients have no trouble swallowing the day after surgery, they will advance to a soft-food diet and be allowed to leave the hospital. Patients should avoid foods such as breads, bagels, meat, and raw vegetables for a couple of weeks. Patients may then resume a normal diet if there is no problem with swallowing.

Medication, such as a proton pump inhibitor (for example, Prilosec OTC®), and antireflux surgery represent two different approaches to the treatment of GERD. PPIs decrease acid production in the stomach but don't actually strengthen the esophageal junction, so reflux can continue.

Though this continued reflux is often painless and may go unnoticed by the patient, it could continue to damage the lining of the esophagus. This could lead to further complications, including Barrett's esophagus, which is a change in the lining of the esophagus that can lead to cancer. Furthermore, esophageal symptoms such as hoarseness, sinusitis, and bronchitis/asthma may not be affected by neutralization of the secretions.

Surgery is directed at increasing the pressure at the junction between the esophagus and the stomach, eliminating reflux into the esophagus.

In some cases, the success of taking a PPI is an indication that a patient would be a good candidate for surgery due to the positive outcomes of taking the medication. Surgery is an option for selected patients with severe chronic heartburn that disrupts their lives, despite lifestyle modifications and appropriate medication.

Patient age and surgical risks are taken into consideration. An elderly patient with severe concurrent diseases who is considered a high risk for a surgery might be better served by non-surgical treatment of esophagitis and reflux. On the other hand, young patients on a PPI theoretically will need to be treated for the rest of their life, which may be decades. There is the inconvenience and expense of taking medication for the rest of the patient's life, which can be considerable, especially if the reflux is hard to control and the patient is on large doses of medication.

Diagnostic testing is critical for all patients to document the disease and determine whether surgery is an appropriate option. Before surgery, a diagnostic evaluation must be made to ensure that gastroesophageal reflux is the underlying cause of the patient's symptoms. This is usually done with 24-hour esophageal pH monitoring, endoscopy, and/or a manometry test.

Probably not, but the entire series of tests may not need to be repeated. Provide your physician with the previous results the first time you meet. Your physician will be able to advise you if any of the tests need to be repeated to determine whether surgery is appropriate.