Nissen Surgery for Gastroesophageal Reflux Disease

A live webcast originating from the “Operating Room of the Future” at the University of Maryland Medical Center in Baltimore showed minimally invasive surgery to treat a serious form of heartburn, called gastroesophageal reflux disease (GERD).

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During the procedure, a laparoscopic Nissen fundoplication, surgeons made five small incisions and used a laparoscope (a long, thin instrument that contains a video camera) to repair the lower esophageal sphincter, a muscle that separates the stomach and esophagus. Normally, that muscle closes after a person eats or drinks to keep food and stomach acids from returning up into the esophagus. But in people who experience chronic reflux, the muscle does not stay closed tightly or is unable to close properly, and they have heartburn, chest pain, cough, difficulty swallowing or regurgitation. Left untreated, reflux can lead to serious complications, including esophageal ulcers or bleeding.

Gastroesophageal Reflux Disease

“The beauty of this procedure is that we make the repair using the patient’s own anatomy,” says Adrian E. Park, M.D., head of General Surgery at the University of Maryland Medical Center and professor of surgery at the University of Maryland School of Medicine.

“In this procedure, we wrap a part of the stomach known as the gastric fundus around the lower esophagus, which prevents the flow of acid back into the esophagus,” adds Dr. Park, who will perform the surgery during the live webcast.

J. Scott Roth, M.D., head of surgical endoscopy at the University of Maryland Medical Center and a faculty member of the University of Maryland School of Medicine, explained the progress of the operation during the live webcast, and provided background information about the procedure.

Paul Castellanos, M.D., assistant professor of surgery at the University of Maryland School of Medicine and medical director of the Center for Voice, Swallowing and Esophageal Disorders at the University of Maryland Medical Center, will also be in the operating room during the webcast. Dr. Castellanos is an otolaryngologist who works closely with Dr. Park. He practices the subspecialty of laryngology along with head and neck surgery. He has coined the term “Laryngopharyngeal Extra-esophageal Reflux Disease,” or LERD, as an entity related to GERD but often the source of puzzlement to clinicians because these patients have reflux related throat disease without commonly having heartburn. They do not often have abnormalities of the lower esophagus such as erosions, ulcerations, strictures or Barrett’s esophagus, a premalignant condition related to GERD.

“Patients with LERD are often misdiagnosed and can have their condition progress to permanent voice loss, airway strictures, lung disease and even head and neck cancer,” explains Dr. Castellanos.


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