The Role of Surgery in GORD What is

What is GORD? Gastro-Oesophageal Reflux Disorder ● ● ● Present in around 10% of

Management of GORD � Generally requires long term management � Symptoms relieved in less

Indications for Surgery � Effective � treatment of severe cases of GORD 91% Success

Surgical Management of GORD Involves surgically improving the viability of the lower oesophageal sphincter

Nissen Fundoplication � http: //simple-med. blogspot. co. uk/2011_05_01_archive. html � http: //www. youtube. com/watch?

Toupet Fundoplication Canon C L et al. Radiographics 2005; 25: 1485 -1499 © 2005

Other Surgical Techniques Endoluminal gastroplication ● Uses an endoscope to fold the oesophagus and

Surgical Outcomes � Removes the need for long term medication � Laparoscopic ◦ Reduce

Summary Both medical and surgical methods Both effective – around 90% Cost effectiveness ●

References/Further Reading Web Reference 1: http: //www. surgeons. org. uk/generalsurgery-tutorials/gastro-oesophageal-reflux-diseasegord. html ● ● Menezes,

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The Role of Surgery in GORD

What is GORD? Gastro-Oesophageal Reflux Disorder ● ● ● Present in around 10% of the population Symptoms or damage to the mucosal lining of the distal oesophagus Caused by the contents of the stomach spending a period of time in the distal oesophagus Symptoms are not related to the severity of the damage Usually a chronic condition with relapses Menezes, N (2007), Surgeons Net

Management of GORD � Generally requires long term management � Symptoms relieved in less than 20% of patients without medication 80% need it for relief � Antacids � PPI’s � In to control episodes of heartburn such as Omeprazole to control gastric acid severe cases surgery is an option � Oesophagitis � Barrett's Oesophagus Menezes, N (2007), Surgeons Net

Indications for Surgery � Effective � treatment of severe cases of GORD 91% Success rate needs good selection of patients � Those with a poor response to medical treatment Patient choice � Barrett’s Oesophagus � � Persisting Volume reflux � Regurgitation � Difficult of gastric contents benign strictures Menezes, N (2007), Surgeons Net

Surgical Management of GORD Involves surgically improving the viability of the lower oesophageal sphincter Nissen Fundoplication Toupet Fundoplication

Nissen Fundoplication � http: //simple-med. blogspot. co. uk/2011_05_01_archive. html � http: //www. youtube. com/watch? feature=play er_detailpage&v=h. RIDVQgv 5 Ek#

Other Surgical Techniques Endoluminal gastroplication ● Uses an endoscope to fold the oesophagus and stitch in place to reduce diameter at the gastro-oesophegeal junction Endoscopic injection of bulking agents ● Endoscope used to inject a bio-compatible polymer substance around the gastro-oesophageal junction. http: //guidance. nice. org. uk/IPG 404 http: //guidance. nice. org. uk/IPG 55

Surgical Outcomes � Removes the need for long term medication � Laparoscopic ◦ Reduce scars, recovery time etc � Side ◦ procedures the norm effects Dysphagia, belching, bloating and flatulence � Oesophageal motility disorders have the possibility to worsen outcomes ◦ Achalasia Menezes, N (2007), Surgeons Net

Summary Both medical and surgical methods Both effective – around 90% Cost effectiveness ● Equals out after 3 years vs medical treatments Improvement can be increased though losing weight, stopping smoking and reducing alcohol intake

References/Further Reading Web Reference 1: http: //www. surgeons. org. uk/generalsurgery-tutorials/gastro-oesophageal-reflux-diseasegord. html ● ● Menezes, N (2007), Surgeons Net Also contains list of papers for further reading Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults (2010: 3) Wileman SM, Mc. Cann S, Grant AM, Krukowski ZH, Bruce J, Cochrane Database of Systematic Reviews, John Wiley & Sons/ The Cochrane Library