At DHI’s Mickle Center for Reflux and Esophageal Disorders, surgeons Dr. Alexander Rosemurgy and Dr. Sharona Ross specialize in operations that correct the anatomy of the esophagus and stomach so that gastroesophageal reflux no longer occurs.
Surgical treatment for GERD is called fundoplication. A fundoplication fixes the lower esophageal sphincter valve (LES). When the LES does its job properly, stomach contents stay out of the esophagus. If you have a hiatal hernia, which is very common, it will also need to be repaired during surgery.
There Are Two Main Forms of Fundoplication:
- Nissen fundoplication. With this procedure, the upper part of the stomach (the fundus) around the LES to strengthen this valve. When this is done, acid is prevented from flowing from the stomach into the esophagus.
- Toupet fundoplication. If the upper gastrointestinal study shows that food does not move down the esophagus well, your stomach will be wrapped around the LES three-quarters of the way instead of completely around as with a Nissen fundoplication.
Dr. Rosemurgy and Dr. Ross have treated thousands of patients with GERD. They are believed to have one of the world's largest experiences in treating GERD with fundoplication and one of the world's largest databases of patients treated for GERD.
To view actual footage of these surgical procedures, please visit the PROCEDURE VIDEOS.
The Minimally Invasive Surgical Approaches Used at DHI Include:
Conventional Laparoscopic Fundoplication
Laparoscopic fundoplication has been around for more than 35 years, and DHI’s surgeons have offered more than 2,000 patients this approach. It involves five small incisions, including one at the belly button. Special instruments are inserted through theses incisions that allow the surgeon to see the surgical site and perform the operation. Laparoscopic fundoplication typically leads to superior outcomes with lasting results. The large majority of patients find that their GERD symptoms are significantly reduced, and many find complete relief from acid reflux.
Some patients, such as those who have a lot of abdominal scarring from previous surgeries, are unable to have a laparoscopic fundoplication. In the past, these patients would have needed an open procedure that would have resulted in a large abdominal scar. However, today DHI’s da Vinci® Surgical System has made it possible for more patients to have a minimally invasive operation despite having undergone previous abdominal surgeries.
The robotic fundoplication procedure is a lot like the laparoscopic fundoplication described above. However, the surgeon sits at a console, where she or he views high resolution images of the site. From the console, the surgeon moves small instruments that control the robot. The robot translates the surgeon’s hand movements and is able to make very fine and accurate motions in small, confined places.
Laparo-Endoscopic Single Site Scarless Surgery (LESS) Fundoplication
Dr. Rosemurgy and Dr. Ross are known for an operation that relieves or dramatically decreases GERD symptoms without a visible surgical scar. They now perform nearly all of their fundoplications with a minimally invasive approach called laparo-endoscopic single site, or LESS, surgery that they pioneered together as some of the world’s most experienced surgeons for fundoplication.
When performed by an experienced surgeon, LESS fundoplication is equally as successful as conventional laparoscopic fundoplication. LESS involves the same surgical plan as conventional laparoscopic and robotic fundoplication. However, instead of several incisions, it requires only one very small incision in the umbilicus. Patients are left with only one scar, hidden in the belly button, and no visible signs of an operation. Also, compared to other fundoplication approaches, LESS surgery involves less pain, faster recoveries and shorter hospital stays.
Experience Matters When It Comes to GERD Operations
Dr. Rosemurgy and Dr. Ross are known leaders in performing minimally invasive procedures for a wide array of diseases. Patients who come to them benefit from their expertise and experience. They pioneered the LESS surgery approach for GERD, and together, they have completed more than 1,500 LESS fundoplications.
These DHI surgeons have written extensively on GERD and this approach, and they have presented about LESS fundoplications at many national and international surgery meetings. Their extensive experience translates into outstanding patient outcomes, and a large majority of their patients are able to stop taking PPIs.