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Surgery for chronic acid reflux goes scarless

A resident of Los Altos, Calif., recently became the first patient at Stanford Hospital & Clinics to undergo a scarless surgery for gastroesophageal reflux disease. Until a few years ago, surgery for the disease, also known as chronic acid reflux, could only be performed through a traditional open chest or laparoscopic approach, which involves inserting instruments through several abdominal incisions.

The development of the EsophyX has changed that. "The ability to do this procedure through the mouth -- with no dissection around areas where there are nerves -- is a quantum leap forward," Stanford surgeon John Morton, MD, MPH, told me.

The EsophyX, as I describe in a press release,

looks like a high-tech fishing pole. With the patient under general anesthesia, the flexible rod is inserted through the mouth and throat until it reaches the stomach. There, a small, retractable wire grabs a 1- to 2-inch section of the stomach wall and pulls it down. The two sides of the resulting flap are then pressed together and shaped with the help of a tissue mold and held in place with plastic fasteners. The process is repeated on adjoining sections of stomach wall until a 270- to 310-degree semi-circular valve is formed just beneath the lower esophagus. The valve looks like a three-dimensional omega: Ω.

Chronic acid reflux is more common than you probably think. Roughly 10 to 20 percent of people living in the Western world suffer at least weekly from heartburn or the regurgitation of stomach acid, or both, according to a 2005 review in the journal Gut (subscription required). Some studies put the incidence even higher. And while lifestyle changes, such as losing weight and elevating one's head while sleeping, and medication, including proton-pump inhibitors, can help to manage the disease, many turn to surgery when these remedies fail. According to a 2008 study in the World Journal of Surgery, EsophyX was effective at reducing symptoms. I cite results of that study in my release:

A year after surgery, 81 percent of the patients were able to stop using proton-pump inhibitors completely, the study said. The study also said that 56 percent of patients were cured, based on their discontinuation of the medication and the reduction of symptoms. The most common adverse side effect was pain in the left shoulder. This affected 18 percent of patients in the study. Other side effects included abdominal pain (15 percent), sore throat (8 percent) and nausea (8 percent). In practically all cases, these side effects lasted no longer than a month.

Photo by Phoney Nickle

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