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Gastroesophageal Reflux and Surgery

  • Juan A. Tovar
Chapter

Abstract

Gastroesophageal reflux (GER) is a complex phenomenon involving always a failure of the anti-reflux barrier and often other components like dysmotility, alkaline refluxate, or delayed gastric emptying. Acid exposure of the esophageal mucosa can be fought with PPI, but no effective medication for alkaline reflux or dysmotility is available. The anti-reflux barrier can be surgically refashioned by elongation of the intra-abdominal esophagus and accentuation of the angle of His (gastropexy) accompanied by creation of a half-valve (Thal and Boix-Ochoa operations) or incomplete (Toupet operation) or complete wraparound using the fundus (Nissen operation). All these operations can be performed laparoscopically. Sometimes, the anti-reflux procedure is accompanied by a gastrostomy for nutritional purposes, and very rarely, a gastric outlet procedure is necessary for facilitating gastric emptying.

All operations may have complications like wrap failure, gas bloat, dumping, and even mortality. In some particular indications in which the various pathogenic factors persist after operation (like in neurologic, respiratory, esophageal atresia, or diaphragmatic hernia patients), the proportion of failures is considerable.

When GER cannot be controlled by anti-reflux surgery, esophagogastric dissociation or feeding jejunostomy with gastrostomy may help.

Surgery is the only effective way of addressing barrier failure, but it would be as naïf to pretend that it is always the solution as to trust solely long-term acid suppression medication. A reasonable combination of both approaches is certainly the most appropriate way of treating GER.

Keywords

Gastroesophageal reflux Surgery Fundoplication Boerema Nissen Thal-Ashcraft Boix-Ochoa Toupet Esophagogastric dissociation Jejunostomy Gastrostomy Gas bloat Dumping Dysphagia 

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Authors and Affiliations

  1. 1.Department of PediatricsUniversidad Autonoma de MadridMadridSpain
  2. 2.Department of Pediatric SurgeryHospital Universitario La PazMadridSpain

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