Anti-reflux surgery is a surgical treatment method that repairs and strengthens the stomach valve in order to prevent the backward escape of stomach contents into the esophagus (reflux).
✓Overview
Gastroesophageal reflux (GER) or reflux disease in short is defined as symptoms resulting from the leakage of acid-peptic gastric fluid or sometimes alkaline secretions from the stomach into the esophagus, or pathological changes in the esophagus. When gastric contents that reflux into the esophagus cause lesions detected endoscopically in the esophagus, it is called Reflux Esophagitis. On the other hand, if a patient has symptoms of reflux but no endoscopic damage, this condition is called Nonerosive Reflux disease.
✓What are the symptoms?
Gastroesophageal reflux, GER is one of the most common diseases. Retrosternal burning (burning behind the chest, heartburn, sour taste in the mouth), which is the most important symptom of this disease, is seen in 45% of individuals in Western societies once a month and in 7% at least once a day. Atypical symptoms for reflux include noncardiac chest pain, asthma, pneumonia, hoarseness, dental lesions, and bad breath. The main complications it causes can be listed as follows;
Bleeding
Ulcer
Stenosis
Barrett's esophagus
Distal esophageal carcinoma
Pulmonary fibrosis
Asthma
Chronic bronchitis
Pneumonia
Laryngitis
Vocal cord ulcers
Laryngeal stenosis
Pharyngitis
Torticollis
Loss of tooth/gingival structures
Oral ulcers
Otitis
✓Chronic sinusitis
✓How is reflux diagnosed?
Diagnosis is made through patient history and endoscopy (Gastroscopy). If the patient's complaints are severe but there are no significant findings on endoscopy, 24-hour pH monitoring is performed.
✓Reflux Surgery Applied Methods
Laparoscopic (Closed) Fundoplication: It is the most commonly used closed surgical method performed with 4-5 small incisions made in the abdomen today.
Nissen Fundoplication: It is the most frequently preferred technique where the upper part of the stomach is completely wrapped (360 degrees) around the lower end of the esophagus to create a new valve mechanism.
✓Post-operative
In 85-95% of patients, reflux complaints and medication requirement are completely eliminated.
Due to the closed method, hospital stay and recovery time are quite short.
After surgery, nutrition with liquids and soft foods is recommended in the first weeks.
✓What is Anti-reflux Mucosectomy (ARM)?
It is an alternative method to surgery that has been safely used in the world and in our country for a long time. It is applied in advanced endoscopy centers. This method applied to eliminate reflux disease is an endoscopic method, but the difference from normal endoscopy is that it is performed under general anesthesia rather than local anesthesia. However, it can also be performed with sedation without general anesthesia, but general anesthesia is sometimes especially preferred. In the procedure, the part called the lower valve of the esophagus is cut with a special technique. The mucosal incision made heals with contraction. As it heals with contraction, the width that causes reflux in the area narrows. Thus, reflux complaints are eliminated.
✓How is Anti-reflux Mucosectomy (ARM) performed?
It is generally performed like a normal endoscopy procedure. The only difference from normal endoscopy is that it is performed under general anesthesia rather than local anesthesia. However, it can also be performed with sedation without general anesthesia, but general anesthesia is sometimes especially preferred. The patient comes to the hospital with 8 hours of fasting. Then endoscopically, the part called the lower valve of the esophagus is cut with a special technique. The mucosal incision made heals with contraction. As it heals with contraction, the width that causes reflux in the area narrows. Thus, patients' reflux complaints are eliminated. After the procedure, the patient is awakened from anesthesia. About 2-3 hours later, liquid nutrition is started first, then solid nutrition is started, and the patient is discharged. Hospitalization is not required for this procedure; it is a same-day procedure. At the same time, return to work and social life can be achieved on the same day. Reflux medications continue to be used for a while after the procedure. However, they are gradually reduced in a controlled manner and discontinued at the end of the 2nd month. Already at the end of the 2nd month, the expected healing in the ARM procedure has occurred, and patients' reflux problems that could not be controlled with medication have been eliminated without surgery.
Recovery after anti-reflux surgery is usually rapid and most patients can return to their normal activities within one to two weeks.
Some patients may temporarily experience difficulty swallowing, bloating, or mild discomfort, but these symptoms typically resolve within a few weeks.
Dietary adjustments are made for proper recovery, solid foods are gradually reintroduced, and regular follow-ups are performed.
Patients are advised to eat smaller meals, avoid carbonated beverages, and limit acidic foods. These habits support long-term success.
Anti-Reflux Surgery: Who is it performed on?
Patients whose symptoms do not resolve despite medication therapy. Patients with hiatal hernia. Young patients who do not want to continue medication use for life. Patients who develop severe damage or ulcers in the esophagus.
How is the Surgery Performed? Is the Stomach Cut?
It is usually performed using a closed (laparoscopic) method. No cutting or removal of tissue is performed on the stomach or esophagus. The upper part of the stomach is wrapped around the lower end of the esophagus to create a new barrier (valve).
How Long Does the Surgery Take and What is the Hospital Stay Duration?
The surgery takes an average of 1 to 2 hours. Patients are usually discharged within 1-2 days after surgery.
Can Normal Food be Eaten After Surgery?
For the first few weeks, nutrition must consist of liquids and soft foods. Approximately 1 month later, a gradual transition to a normal diet is made.
Does Reflux Recur After Surgery?
The success rate is quite high, but very rarely, reflux can recur years later due to loosening of the wrap.
What is Anti-reflux Mucosectomy?
Anti-reflux mucosectomy refers to the narrowing that occurs during the healing phase after shaving of the mucosa of the lower esophageal sphincter, which is the part of the gastrointestinal system that causes reflux—that is, the mucosa where the esophagus joins the stomach. Performing mucosectomy means preventing reflux.
Is Anti-reflux Mucosectomy (ARM) a complete alternative to surgical method?
No, it is not. Surgery is the method used in the final stage, but there is a bridge process between medication therapy and surgery. It is a method used instead of applying surgery to patients unnecessarily in the early period. Or it is used when ARM method is resorted to instead of applying medication therapy when results would not be achieved.
Can Anti-reflux Mucosectomy (ARM) be applied in the presence of hiatal hernia?
No, in the presence of hiatal hernia, the results of ARM are not successful, and therefore it is not applied.
Can Anti-reflux Mucosectomy (ARM) be performed in reflux cases that develop after sleeve gastrectomy?
It has begun to be preferred recently both in the world and in our country. Because patients have little chance of anti-reflux surgery after sleeve gastrectomy. For this reason, ARM can be used as anti-reflux treatment.
Can Anti-reflux Mucosectomy (ARM) method be applied to all reflux patients?
It can be applied to many. However, these patients must not have very severe wounds in their esophagus. They must not have hiatal hernia. There must be no motility movement disorders of the esophagus. Finally, they must not have achalasia disease. ARM method can be applied to all reflux patients who meet these conditions.