Anti-Reflux Surgery General Information Gastroesophageal reflux disease (GERD) is the medical description of what is commonly known as “heartburn.” Although other problems can cause heartburn symptoms, GERD is the most common. GERD can also cause symptoms such as asthma and can even lead to a higher risk of pneumonia. GERD is caused by stomach acid which flows abnormally back into the esophagus. Frequently, GERD is due to an abnormally large opening in the diaphragm which allows part of the stomach to move up into the chest from its normal position in the abdomen. This is known as a hiatal hernia. Hiatal hernia and GERD can cause significant symptoms, but may also lead to severe problems including an increased risk of esophageal cancer. Often reflux can be treated with weight loss and powerful antacid medications; however, when the symptoms of reflux continue despite maximal therapy with medications, surgery might be needed to correct the problem. Additionally, if your gastroenterologist has seen signs of esophageal irritation from acid exposure, you might be a candidate for anti-reflux surgery. Several tests need to be done prior to surgery. These include upper endoscopy (looking inside the esophagus and stomach with a lighted camera), manometry (testing how well the esophagus propels food), pH probe testing (to document the abnormal acid exposure to the esophagus), and/or a barium swallow. The operation most commonly performed for reflux is called a Nissen fundoplication. During this procedure, the top part of the stomach is wrapped around the lower part of the esophagus to create a new valve between the stomach and the esophagus. Additionally, any evidence of hiatal hernia is repaired at the same time. Usually this operation is performed laparoscopically through several small incisions; however, your unique situation may not allow for the procedure to be done laparoscopically. Your surgeon will discuss that with you at the time of your consultation. After the surgery, you will be placed on a special diet for 4-6 weeks to help the surgery heal without complications. Your surgeon will discuss the details of the diet with you prior to the operation. You will need to stay in the hospital overnight after your surgery for observation and monitoring. The Procedure When you arrive, you will go to the preoperative preparation area where a nurse will review your medical history and an IV will be started. If you haven’t already done so, you will meet with an anesthesiologist at this time. When the operating room is ready for you, you will be taken in on a stretcher and will meet the operating room nurses who will help take care of you during the procedure. If you didn’t see your surgeon in the preoperative area, you will see him in the operating room prior to the beginning of the procedure. You will then move onto the operating room table and the anesthesiologist will give you medication to make you fall asleep. Your surgeon will then perform the procedure while you are completely asleep. When the surgery is completed, you will be taken to the recovery area where you will slowly wake up and regain complete consciousness. A nurse will give you any medication you need and monitor your vital signs and pain level as you wake up. Your surgeon will speak to your friends or family members in the waiting room during this time. Postoperative Information Once you have recovered from anesthesia and your pain is controlled, you will be taken from the recovery area to a hospital room. You will usually be allowed to drink non-carbonated liquids on the day of surgery. Your surgeon will prescribe the remainder of the postoperative diet before your operation, and will review it again afterwards. For more information on postoperative care, please click on this "Inpatient Surgery" link.