What is GERD and robot-assisted surgery

  • Dr. Stacie Perlman —Courtesy

For the Monitor
Published: 11/16/2020 4:45:57 PM
What is GERD?

Gastroesophageal Reflux Disease (GERD) is a digestive disorder that occurs when the connection between the esophagus and stomach, or Lower Esophageal Sphincter (LES), becomes weak and allows stomach acid and bile to flow back up into the esophagus. This causes pain, tissue damage, and even cancer. Normally the LES closes immediately after swallowing; however, with GERD, it is weak allowing for this reflux. GERD is the most common gut complaint in the United States with 20-30 percent of the population affected by it. It is frequently referred to as acid reflux or heartburn.

Why have surgery to treat GERD?

Medication is often used to manage the symptoms of GERD, but the interesting thing is it is an anatomic, or structural, problem. Trying to treat it with medicine makes the symptoms better but it doesn’t cure the disease. All we are doing is making the reflux hurt less; it is still happening. Surgery can fix the LES, alleviating symptoms and preventing further damage that can lead to cancer.

What is involved in the surgery?

The gold standard has been a procedure called Nissen fundoplication. We wrap the stomach behind itself and create a new valve to prevent acid and bile from coming back up. This has been done previously as an open procedure, with minimally-invasive laparoscopy, and, more recently, robotically.

Why use a robot?

In trying to be a good steward of medical spending, there are some cases I do not feel I need a robot for, and some things I do. It’s not just the cost; I’m looking for patient outcomes, patient comfort, and whether or not I feel I can perform the surgery better with a robot. The robot allows us to do things laparoscopy cannot. It keeps the surgery minimally-invasive, which decreases the length of hospital stay, reduces the formation of scar tissue and repeat admissions, makes the recovery time much faster, and decreases pain medication and narcotics use. A relatively new medical device called LINX has advanced surgical options even further.

What is the LINX System?

The easiest way to think about it is like a beaded bracelet. LINX is a ‘bracelet’ of magnetic titanium steel beads that sits around the LES, where the esophagus meets the stomach. When you swallow food or drink, the beads are pushed apart slightly to allow what you consumed to pass into your stomach. Once you are done swallowing, the beads link back together to keep reflux from coming up. The nice difference from a fundoplication is that it moves back and forth. When a surgeon wraps the stomach around itself, the opening can’t get bigger or smaller, so in essence, we have to guess the right size. LINX comes in multiple sizes and is designed to fit each patient uniquely. It also greatly decreases surgical time and allows the patient to immediately go back to eating regular food.

(Dr. Stacie Perlman is a board-certified general surgeon at Concord Hospital. She is also fellowship-trained in minimally-invasive surgery, robotics, and bariatric surgery. Dr. Perlman presented on reflux and robotics at the September Concord Hospital Trust “What’s Up Doc?” Donor Lecture Series. The monthly series features members of Concord Hospital’s medical staff speaking to Concord Hospital Trust donors about new and innovative medical treatments and services. You can watch Dr. Perlman’s presentation on Concord Hospital’s YouTube channel at youtube.com/concordhospital.)

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