University of Virginia Health System

MINIMALLY INVASIVE SURGERY TO RELIEVE CHRONIC HEARTBURN PERFORMED AT U.VA. HEALTH SYSTEM

While this surgery isn't right for everyone, if patients experience heartburn more than twice a week or still have symptoms after taking medication, they may be a candidate, said Dr. Bruce Schirmer, a surgeon at U.Va.

Chronic heartburn may be an indication of gastroesophageal reflux disease or GERD, Schirmer explained. Left untreated, GERD can cause serious complications including severe narrowing or obstruction of the esophagus, chest pain, bleeding and a pre-cancerous change in the lining of the esophagus.

GERD occurs when the muscle between the stomach and esophagus weakens, allowing stomach acid to flow back into the esophagus. It is usually characterized by frequent, persistent episodes of heartburn as well as indigestion, regurgitation, difficulty sleeping after a meal and a sore throat. To relieve the symptoms of GERD, the surgeon wraps a small portion of the stomach around the lower esophagus to prevent reflux of acid to the stomach.

In the past, surgery to treat GERD required a long incision in the abdomen, resulting in a lengthy recovery time. At U.Va., the procedure is now being performing laparoscopically. This means the surgeon makes only five to six dime-size incisions, and special surgical instruments including a laparoscope, a small, fiber-optic camera, are inserted through the openings. The laparoscope transmits images, which guide the surgeon through the procedure, from inside the body to a video monitor. Smaller incisions greatly reduce recovery time, pain and scarring, explained Schirmer who also is director of the Laparoscopy Institute of Virginia.

The results of this surgery are amazing. Many of my patients have had painful, chronic heartburn for years. After the operation, they wake up without it, and it doesn't come back, said Schirmer. Most patients leave the hospital after only a day or two, instead of the week or more with traditional surgery.

Surgeons at U.Va. are now using laparoscopy for almost all abdominal operations including removing the gallbladder or spleen; biopsying or removing liver tumors; treating ulcers; removing areas of the stomach, intestine or colon; and weight reduction operations. The cost of laparoscopy is generally covered by most health insurance plans.

The ACG recommends heartburn sufferers try controlling symptoms with over-the-counter medications and lifestyle modifications. These include avoiding certain foods and beverages, eliminating tobacco and alcohol and losing weight. However, if symptoms persist, sufferers should consult their doctor to determine if GERD is the cause of the problem and what can be done to relieve the symptoms.

March 20, 2000