If you have surgery on your knee, it is possible that you would need another procedure down the road as you get older. The same is true for reflux surgery.
Surgery for reflux is a reconstructive procedure. We take tissue that has already failed once and use that tissue to complete the procedure. Over time as we age, this tissue can break down again. Fortunately this doesn’t happen often – most studies show durability of about 85% at 10 years. We are constantly striving on techniques to increase that success rate.
When considering surgery for reflux, here are a few things you should think about before moving forward with surgery:
1. Go to a specialist. Studies clearly show that results are better in a specialized practice that is dedicated to this disease (a foregut specialist).
Know your surgeon and the team. Ask your surgeon how many procedures they have done, what their complication rate is, who covers for them on the weekend and if they know how to take care of patients with your condition.
2. Have a complete workup done. There are multiple studies that show up to 30% of patients taking reflux medication do not have GERD (gastroesophageal reflux disease). GERD can be very complex and there are other possible explanations for your symptoms. For this reason, we generally require a complete workup prior to recommending surgery. This workup includes an endoscopy (either a sedated endoscopy in a GI lab or a trans nasal endoscopy in our office unsedated), an esophageal motility test, a pH test while you are off your reflux medications for 7 days prior, a stomach emptying study, and a cine esophagram (like a barium swallow- an xray study). We may order additional tests if Dr Bell feels your symptoms might be related to something other than GERD. We will also consult with other specialists (gastroenterology, ENT, pulmonary, allergist) to help narrow down the possibilities for your symptoms.
3. Develop a relationship with your specialist and the team. With our team, we follow our patients closely. If you have any problems after surgery related to reflux, swallowing, recurrent symptoms – we want you to contact us. We know what is normal overall recovery and what needs to be evaluated further (as well as the best approach to managing problems). As mentioned above, we are constantly striving to do better and following our patients and learning from their outcomes is a very important factor.
4. Insurance. This is becoming more and more difficult of an issue. For most of the procedures we do, they are done as an “outpatient” status. We contact your insurance company and let them know all of the codes and procedures we are planning on. Most commercial insurance companies make the statement “no authorization required.” What this means is they will not say ahead of time if they are going to pay for the surgery/procedure or not. They will make a determination if they are going to pay for it based on “medical necessity at the time of the procedure.” Fortunately, with the procedures that we do, we have not had a problem with the insurance companies paying as they should. We will have you sign a form (called an ABN or an advanced beneficiary notice) that says if your insurance denies payment, you will be responsible. We also require guarantee of payment prior to surgery.