Bile Reflux Surgery

In cases of severe bile reflux, surgery may be a patient’s best alternative for relief.  There are a few bile reflux surgeries available, and a doctor will look at the causes and symptoms of your ailment to help determine which route makes the most sense.

Diversion Surgery for Bile Reflux

Diversion surgery is often used in those whose bile reflux is caused by gastric surgery wherein the pyloric valve was removed.  This type of bile reflux surgery utilizes a procedure called Roux-en-Y.  As the name indicates, diversion surgery diverts the bile so that it enters the intestine further down and therefore doesn’t have the same kind of access to the stomach.

The term “diversion surgery” can be a bit confusing, as gastric bypass surgery itself can fall into this category.  There are many other types of diversion surgery, as well.  Diversion surgery for bile reflux focuses specifically on rerouting the drainage of bile into the digestive tract.

Anti-Reflux Surgery for Bile Reflux

This type of surgery, called fundoplication is most often used to treat acid reflux, but there has been some success for bile reflux, as well.  In this procedure, the esophageal sphincter is strengthened as the surgeon wraps part of the stomach around it.  This helps to keep acid and bile from refluxing up into the esophagus.

Anti-reflux surgery may be done either as an “open repair” or as a “laparoscopic repair.”  In the first case, the surgeon makes a larger incision in the abdomen to see the area that is being repaired.  With the laparoscopic approach, three to five small incision are made, and tools are inserted through them.  A tiny camera attached to a flexible endoscope is passed through the mouth and esophagus.  The endoscope transmits what it views to a monitor so that the surgeon can guide the tools and make the repair without creating the larger incision required for an open repair.

When Do You Need Surgery for Bile Reflux?

Your doctor will have particular parameters to follow regarding when to recommend surgery, but some of the common indicators include:

  • Ongoing heartburn that can be treated with medication when the patient doesn’t want to rely on these medications indefinitely.
  • A hernia is present causing part of the stomach to get stuck in the chest or twisted.
  • Your reflux issues are causing other problems that can be significantly dangerous.
  • You are aspirating stomach contents, leading to lung infections.
  • You have developed hoarseness or a chronic cough.

In order to determine your suitability for a particular surgery, the doctor will also perform a variety of tests.  These might include blood tests and liver tests, an esophageal manometry to measure gasses and the pH of your esophagus, and upper endoscopy to visualize damage done by the bile reflux or acid reflux, and possibly x-rays, as well.

Risks from surgery tend to be fairly low, but you will certainly want to discuss them with your doctor.  Of course, there is concern for damage to the stomach, liver, intestine, and esophagus, but this seems to be quite rare.  Gas bloat is more common but generally improves.  Difficulty swallowing is another common complaint, but most people suffer for three months or less before the problem is resolved.