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Videoscopic Surgery

Here’s how it works:

You may be familiar with the gallbladder procedure called videoscopic or laparoscopic cholecystectomy, a less invasive alternative to traditional or “open” surgery. A videoscopic procedure is an alternative to open surgery in which small incisions are made to accommodate small tubes called “trocars”. The trocars create a passageway for special surgical instruments and a laparoscope -a fiber optic instrument used to examine and transmit images from within the body to a video monitor allowing the surgeon to see the operative area.

Open Surgery vs. Videoscopic Surgery

Since the incisions are small (only about the size of a dime), scarring tends to be greatly reduced. Patients who are appropriate candidates for a videoscopic procedure usually experience shorter hospital stays. Like gallbladders, most surgery for chronic heartburn is done videoscopically. However, depending on patient condition, a surgeon may recommend open surgery as the best alternative.

What is Videoscopic Surgery for GERD?

Chronic heartburn or GERD is usually caused by the weakening of a valve above the stomach allowing acids to reflux up into the esophagus. Videoscopic surgery actually addresses the malfunctioning valve, “fixing” chronic heartburn in most cases. In this procedure, a surgeon wraps part of the stomach around the lower esophageal sphincter, which improves the performance of the sphincter preventing the reflux of acids from the stomach into the esophagus and eliminating heartburn.

Here’s a look at the benefits of this alternative:
Open Surgery
1-7″ Incision
Hospital stay of 9 days
Recovery period of 28 days

Videoscopic Surgery
4-6 dime-sized incisions
Hospital stay of 1-3 days (typical stay 2-3 days)
Recovery period of 7-13 days

How successful is the surgery?

Studies show that over 90% of patients are symptom-free after a videoscopic surgical procedure to correct gastroesophageal reflux disease. “The-quality-of-life assessment has been the most dramatically improved outcome variable·” in patients studied.*

* Hunter JG, Trus TL, Branum GD, Waring JP, Wood WC. A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg. 1996;223:673-687.

Is Videoscopic Surgery for Chronic Heartburn Right for me?

Most patients are not candidates for videoscopic surgery. However, videoscopic surgery is an option for selected patients with severe chronic heartburn that still disrupts their lives, despite lifestyle modifications and appropriate medication. Other heartburn sufferers who may benefit from videoscopic surgery include younger patients (50 years or younger) facing a lifetime of medications, patients who find medications a financial burden, patients who are noncompliant with their drug regimen, and patients who prefer a single intervention to long-term therapy. Diagnostic testing is critical for all patients to document the disease and determine whether surgery is an appropriate option. **

Before surgery, a diagnostic evaluation must be made to ensure that gastroesophageal reflux is the underlying cause of the patient’s symptoms. This is usually done with 24-hour esophageal pH monitoring, endoscopy and/or a manometry test.

If you have tried over-the-counter or prescription strength medication without relief, see your doctor or gastroenterologist. Only your doctor can best determine whether you are a candidate for a videoscopic surgical procedure to fix gastroesophageal reflux or GERD. If he or she thinks you can benefit from the procedure, you will then be referred to a surgeon. Your local medical center also can help you find a surgeon skilled in the videoscopic procedure.

** Castell DO, Brunton SA, Earnest DL, et al. GERD: management algorithms for the primary care physician and the specialist. Practical Gastroenterology. 1998;22(4):18-46.