Surgery is an option when medicine and lifestyle changes do not work. Additionally, many people may consider surgery to be a desirable alternative to other types of therapy. You may be considered for surgical treatment after trials on medication and through evaluation. Surgical criteria include:

• Persistent symptoms on medication
• Medication dependency
• Active regurgitation
• Hiatal hernia
• Pulmonary complications
• Strictures requiring dilation
• Dental disease
• Anemia
• Barrett's Esophagus

Currently, the preferred surgical approach is a laparoscopic procedure, meaning that the operation is performed through tiny incisions in the abdomen using miniaturized instruments and videoscopic monitoring.

This technique, called the Nissen fundoplication, entails mobilizing the lower esophagus and upper stomach and then wrapping the upper stomach around the lower esophagus 360 degrees. Trapping the wrap between the posterior vagus nerve and the esophagus is important. This operation increases the lower esophageal sphincter resting pressure, increases the sphincter length, accentuates the closing angle of the esophagus, and accelerates gastric emptying.

As with so many "minimally invasive" surgical procedures, you are usually able to benefit from a shorter hospital stay, a more rapid recovery, and less discomfort than with the "open" alternatives.

After 10 years, there is a 90% success rate following Laparscopic Nissen Fundoplication. The absolute relief of heartburn, regurgitation, chest pain, pulmonary symptoms, and absence of medication is a tremendous benefit of surgery. Progression of Barrett's esophagus can stop and even regress to normal. The temporary side effects of surgery may include trouble swallowing, occasional diarrhea, and bloating.