2. Nissen Fundoplication
• Most common procedure performed
• Most often done laparoscopically
• Open approach may be
recommended for redo surgery or
complex hiatal hernia
• With an experienced surgeon,
90-95% of patients have good
control of typical GERD symptoms
3. Endolumenal Procedures
• Newer procedures performed through
the mouth and without any incisions in
abdomen
• Esophyx TIF and Stretta are only ones
currently available in U.S.
• Not an option in those with moderate to
large hiatal hernia or Barretts
esophagus
• With an experienced surgeon, 60-80%
of patients have control of typical
GERD symptoms
4. Linx Reflux System
• Recently approved by FDA
• Implanted laparoscopically around
end of esophagus
• Outpatient procedure
• Not an option in those with Barretts
or more than 3 cm hiatal hernia
• Only available at select centers
5. Nissen Fundoplication
Pros Cons
• Best studied and most • Most invasive procedure
common procedure requiring incisions in
performed abdomen
• Highest rate of success • Full recovery takes 3-4
weeks
(90-95%)
• Failure requires more
• Hiatal hernia is fixed complex redo surgery
• Outcome dependent on
• Best success with surgeon skill and
atypical GERD
experience
symptoms (80-90%)
6. Endolumenal Procedures
Pros Cons
• No incisions • New - unknown long term
success
• Less pain • Lower initial and early
success rates (60-80%)
• Faster recovery • Unknown results with
atypical GERD symptoms
• If fails, still candidate for • Not many surgeons with
laparoscopic Nissen experience
• Many insurance companies
do not cover
7. Linx Reflux System
Pros Cons
• Mechanically very similar • New - unknown long term
to native esophageal success
sphincter
• Not an option in Barretts or
more than 3 cm hiatal
• No need to alter diet hernia
after surgery
• After Linx implanted patient
can not have an MRI
• Minimal side effects
• Not widely available
• If fails, still candidate for
laparoscopic Nissen
8. Nissen Fundoplication
Details
• 60-90 minute procedure • Most are able to return to
work 2-4 weeks after
• 1 night stay in hospital surgery
• OK to shower the day after
• Risk of complication less surgery
than 1%
• OK to drive when no longer
• No heavy lifting for 4 using prescription pain
weeks after surgery medicine
• No special help needed at
• Liquid/soft food diet for 4 home
weeks after surgery
9. Endolumenal Procedures
Details
• 45-60 minute procedure • Most are able to return to
work 1-2 weeks after surgery
• 1 night stay in hospital • OK to shower the day after
surgery
• Risk of complication less
than 1% • OK to drive when no longer
using prescription pain
• No heavy lifting for 4 medicine
weeks after surgery • No special help needed at
home
• Liquid/soft food diet for 2
weeks after surgery
10. Linx Reflux System
Details
• 30-45 minute procedure • Most are able to return to
work 1-2 weeks after surgery
• No overnight stay • OK to shower the day after
surgery
• Less than 0.1% chance
of complication • OK to drive when no longer
using prescription pain
• Maintain regular diet medicine
immediately • No special help needed at
home