Repair of the LES: A permanent solution for GERD

While many people suffering from gastroesophageal reflux disease (GERD) rely on medications and lifestyle changes to control their symptoms, some people seek a permanent solution – especially when medications and lifestyle fail to provide relief to their satisfaction. Remember, medications only control symptoms. They do nothing to address the underlying cause of those symptoms – a damaged lower esophageal sphincter (LES). The GERD treatment procedures listed here were developed to repair the LES and restore its function as a barrier to prevent reflux from happening at all. When successful, these procedures can keep symptoms at bay and prevent damage to the esophagus and the long-term complications that can result.

Our goal with this page is to provide a quick overview of the different procedures currently available to repair the LES that you may come across in your search for information. We’ll update this page as new information/new procedures become available.

GERD treatment procedures currently available

Nissen Fundoplication

The Nissen fundoplication is considered the standard for sphincter repair surgery. It is a minimally invasive surgical procedure that restores the damaged LES function thereby stopping the reflux. This is accomplished by loosely wrapping part of the stomach around the lower esophagus.

Pros

• Safe and effective.
• High success rate.
• Proven long term success.
• Eliminates or reduces the need for medications.

Cons

• Occasional troublesome side effects.

Learn more about the Nissen Fundoplication:
Overview of antireflux surgical alternatives
What are the most common side effects from a laparoscopic Nissen Fundoplication?

Partial Fundoplications

There are several variations of the Nissen fundoplication, including the Toupet fundoplication, referred to as partial fundoplications. The procedures are used in special circumstances. Like the Nissen, thousands of partial fundoplications have been performed over many years. In a partial fundoplication, the stomach is wrapped only partway around the lower esophagus. This is most often used when function of esophagus has been damaged by long-term reflux.

Pros

• Safe and effective.
• High success rate.
• Proven long term success.
• Eliminates or reduces the need for medications.
• Seemingly fewer side effects than Nissen.

Cons

• Possibly less durable than Nissen (effectiveness decrease over time).

LINX Reflux Management System

The Linx Reflux Management System is the newcomer in the group. During this minimally invasive procedure a magnetic bracelet is surgically placed around the Lower Esophageal Sphincter (LES) to augments its previously impaired function. This procedure has only been in place for a few years, so its present availability is somewhat limited to specific Centers. Availability will continue to increase.

Pros

• High success rate in stopping reflux and eliminating PPI use.
• Minimal side effects.
• Safe.

Cons

• New procedure.
• Long term results yet to be confirmed.
• Not all GERD patients are not candidates for LINX.

Learn more about the LINX Reflux Management System:
New study finds LINX safe and effective for chronic GERD
Ten things you need to know about LINX

Transoral Incisionless Fundoplication (TIF)

During this procedure, a partial fundoplication (partial wrapping of the stomach around the esophagus) is created from inside of the stomach using a special device introduced through the mouth. While the effectiveness of this procedure is still being debated, it is heavily marketed as a non-surgical alternative to the traditional Nissen fundoplication.

Pros

• Minimal pain.
• No scars.
• Fast recovery time.
• Very few side effects.
• Most can reduce or discontinue medications and have improved symptoms.

Cons

• Does not reliably stop the reflux.
• Hiatus hernia, if present, cannot be repaired.
• Not sure about durability.

Stretta

During the endoscopic procedure, precisely controlled radiofrequency energy is delivered to the LES through a special catheter placed through the mouth. Strettta is thought to make the damaged LES “stiffer,” and as a consequence restore its function. This procedure has been available for over 10 years and has not been widely utilized.

SRS Endoscopic Stapling

This procedure performed through the mouth tightens the LES by stapling the upper stomach around the lower esophagus. Conceptually, it is similar to the TIF procedure. Like TIF, this procedure is performed endoscopically. Long-term efficacy has yet to be demonstrated and availability, at present, is limited.

GERD treatment procedures that are no longer available

There are several procedures that you may come across in your online search that are no longer available for a variety of reasons (cost, poor outcomes, high risk). We’ve listed them here for reference:

• NDO Plicator
• Enteryx
• EndoCinch

Educate yourself for better outcomes

If you are considering a procedure to repair your LES, be sure you understand your options, as well as the benefits and risks of each. Talk to your doctor. Do your research. Setting realistic expectations about the outcomes of your procedure – short and long term – will help ensure you’re satisfied with your results. And for the best results, always seek treatment from an experienced physician that specializes in treating patients with GERD.

Next steps

Learn about when to consider surgery: When should I consider surgery for acid reflux?

Reviewed by: Dr. Dengler, RefluxMD Medical Director