Reflux Surgery: Part III
Last Month we discussed several surgical treatment options for GERD. This month I will discuss two more new procedures which have been mentioned in recent medical articles. They are the Transoral Incisionless Fundoplication and the SRS endoscopic stapling system.
The Transoral Incisionless Fundoplication was approved by the FDA to be used with the EsopyXTM device in 2007. During this procedure there are no external incisions, internal dissection or laparoscopic assistance (1). The procedure is done through the mouth and also has the advantage of being able to provide anatomical repair.
Proponents of the TIF procedure also mention the fact that the procedure is reversible and repeatable. Those characteristics may be of benefit to younger patients due to the chronic and potentially progressive nature of GERD. Though there has not been a significant amount of research done on this procedure to date what has been done shows promising results. Patients having this procedure demonstrated "improvement in GERD symptoms, quality of life, esophageal acid exposure, esophagitis, resting lower esophageal sphincter pressure and medication use" (2).
SRS endoscopic stapling system consists of a device much like a gastroscope. Once introduced into the stomach, and positioned correctly, the scope is held firmly in place by screws which extend from the tip of the device. The staples are then fired into the correct position to tighten the LES. Then the screws are withdrawn and the scope is removed (3). The results of the procedure produce a partial fundoplication wrap. According to a recent study the results of the SRS procedure have given patients a reduction in acid exposure and symptom improvement (2).
As with the TIF procedure there has not been much research done on the SRS procedure yet. In fact the NIH is currently recruiting patients to participate in a trial designed to demonstrate the safety and efficacy of the SRS procedure (4). Those results may help to determine how well the procedure will work with GERD patients.
Any surgical procedure presents risk to the patient and those risks should be weighed carefully against the benefit with each individual's physician. That having been said, the new procedures that eliminate incisions are providing a less invasive way to see positive results. Hopefully as the procedures are "tweaked" and improved these new Natural Orifice Surgeries (NOS) will provide an alternative to many patients dealing with GERD.