Maggie McKay (Host): Welcome to Meaningful Medicine, a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.

Joining me is Dr. Tyler Watson, General Surgeon, to discuss medical options to stop suffering from acid reflux. Thank you so much for making the time today, Dr. Watson.

Dr. Tyler Watson: Yeah. Thanks. Thanks for having me. I'm happy to be here.

Host: So let's just start with what is acid reflux?

Dr. Tyler Watson: Yeah. Acid reflux is very common. It is when you have in the medical community, we call it gastroesophageal reflux disease or GERD. Basically the stomach creates acid fluid to help you digest food. Sometimes that acid in the stomach contents can move back up into the esophagus or reflux into the esophagus. And that's what gastroesophageal reflux disease is.

Host: And if it's untreated, what damage can acid reflux cause?

Dr. Tyler Watson: Well in terms of symptoms, it can be pretty miserable for patients. It can cause burning, people can have a hard time lying flat at nighttime and have to sleep elevated on pillows. People can actually have it so bad that they'll actually regurgitate food that they just ingested.

some less common symptoms, but sometimes very serious symptoms, it can cause like chronic pneumonias, if the reflux is going all the way up and back down into the lungs. In terms of damage to the esophagus, what we really worry about is having chronic acid reflux can increase your chances of having certain types of esophageal cancer.

Host: Wow, I had no idea there was so much involved with it. When should a patient speak to a doctor about medical treatments or interventions?

Dr. Tyler Watson: Sure. I mean, I think, there's a ton of over the counter options for treating mild acid reflux. But if it's something that's starting to affect your everyday life it's certainly worth at least having a conversation with your primary care physician. Many people, kind of the first place where they end up is in with a gastroenterologist.

And usually kind of the first step in working this up is the gastroenterologist will, put a camera down with a, doing an EGD or an upper endoscopy to take a look at the inside of the esophagus and the stomach.

Host: How do you know if it's heartburn or acid reflux or is that the same thing?

Dr. Tyler Watson: It's the same thing. Sometimes heartburn can be a little bit wider range and less specific than gastroesophageal reflux. But, doing a workup can help differentiate between that.

Host: Dr. Watson, what can you do as a surgeon to help patients who are suffering from acid reflux?

Dr. Tyler Watson: A lot of people don't realize that we have different surgical options to treat that. Whether it's because people just don't want to be on medical therapy for 30, 40 years, or if, sometimes despite trying multiple different types of medicines, they fail and the medicines aren't working to help control their symptoms.

And then another major reason that we do surgical interventions is if patients develop esophagitis, where the lining of the esophagus is actually inflamed because it's being bathed in that stomach acid that it's not meant to handle. And, that's what actually can lead to the increased risk of cancer. The tissue of the esophagus can start trying to turn into a different type of tissue that could handle the acid.

And that's called Barrett's esophagus. And that type of metaplasia where one cell is trying to turn into a different type can lead to increased risk of cancer. So those are some of the indications for maybe having a conversation with a surgeon. There's several different approaches to managing reflux with surgery.

We definitely always want to do a good workup, before, so we have all the information prior to considering an operation. And so we want to make sure that the esophagus works, so we want to make sure that we understand the anatomy. We want to make sure that we have the correct diagnosis so that we know what we're treating.

Many people that have reflux, one of the main reasons why they're having it is they actually have a hernia at the diaphragm called a hiatal hernia or a parasophageal hernia. So we want to know if that's there because fixing that is part of the surgical treatment many times for treating the gastroesophageal reflux disease.

And then, to put it in simple as terms as possible, most surgeries to treat reflux, their goal is to basically make the valve at the junction in between the esophagus and the stomach work better or to create a new type of almost artificial valve to allow food to pass into the stomach, but not allow acid and stomach contents to reflux back into the esophagus.

The one that I do the most commonly, in the operating room is if people have a hiatal hernia where the stomach is up in the chest, I do this robotically, it's minimally invasive surgery. I will go in with long instruments and get the stomach back down into the abdominal cavity where it's supposed to be.

And then I will repair the hernia that the stomach was sliding to up into the chest. And then I will do what's called a fundoplication, which is fancy terms for I will wrap the stomach around the esophagus to help create that valve to make sure that the reflux is not going back up where it's not supposed to be.

Host: Oh my goodness. Are there any risks to that surgery versus the relief and benefits?

Dr. Tyler Watson: Yeah, there's always risks to every surgery. You know, it's a major operation. It's general anesthesia. You have to be put all the way to sleep with the breathing tube. So anytime you're doing that, there's risk of heart attack, stroke, respiratory failure. And then in terms of the complications, possibilities for the surgery itself, the main one that we worry about is the hernia coming back, which the hernias can recur over time. Or you could have some type of damage to the tissue around where you're operating or bleeding. But the large majority of the patients that I do this operation on are incredibly happy. They spend one night in the hospital.

The biggest sort of post operative hurdle for most patients is once you have the wrap done, you have to stay on kind of a liquid diet for several weeks, while the wrap heals and you get used to your new anatomy. And that's really a tough kind of post operative recovery. Once you get past that, these are some of the happiest patients that I have.

Host: I bet. So the outcomes you tend to see after surgery are generally very good. And is this a permanent fix?

Dr. Tyler Watson: That's the hope is you can completely come off your reflux medication. And, many times, especially if people have that esophagitis or the pre cancer that we were looking for, we'll continue to screen for that. And we can kind of see over increments of time, that tissue began to repair itself and normalize, which is always really exciting.

Host: Well, big congratulations. You just completed your 1000th robotic surgery. That is amazing. Especially after hearing how complicated it is, including the ones you do for acid reflux. What are the benefits of robotic surgery for a condition like this? 

Dr. Tyler Watson: I'm a huge, obviously believer in robotic surgery. The biggest advantages of robotic surgery, obviously, the big difference is minimally invasive surgery versus open. Minimally invasive operations, patients have obviously much smaller incisions, less pain, less use for narcotics, less chance of having some type of hernia or wound complication, faster recoveries, shorter stays in the hospital. I mean, this is all very well established. And we've been doing laparoscopic surgery, which some people call straight stick surgery for years. And robotic surgery is just the next step for laparoscopic surgery. The biggest differences are I can drive my own camera.

I don't have to have somebody else holding it. And so I can make sure I'm looking at exactly what I want to be looking at. And I can see it in 3D. I can control three separate working arms. So instead of just having two hands, I'm actually working with three hands at one time, which is really great for exposure and retraction and being able to do more complex operations through those small incisions. 

The other major difference with robotic surgery is the instruments are wristed. So instead of just being able to stand at bedside and move those sticks straight, I, once I put the instruments in, I actually, the wrists articulate and it's particularly advantageous when you're working up in the chest in a small space with, you're working right around the heart and the lungs and the aorta and there's, it's high value property up there, so you want to be able to be as precise as possible.

Host: That is amazing. Has robotic surgery been around as long as you've been a surgeon?

Dr. Tyler Watson: Robotic surgery was in the general surgery world was like just starting to catch on when I was in residency. I finished residency in 2017, but it had been around probably 10 years before that, but in terms of general surgery applications, and then it has actually really exploded over the last six, seven years. There were actually more robotic operations performed in America last year than laparoscopic surgeries. 

Host: Wow. Interesting. In closing, is there anything else you'd like to add that we didn't discuss?

Dr. Tyler Watson: We covered a lot of it. I guess one thing in terms of particularly talking about the gastroesophageal reflux disease. A lot of times, patients don't know. And a lot of times, even some of the primary care doctors don't know that there can be surgical treatment.

And so if you're really interested in that, if it's, you know, you feel like you have a severe case, definitely don't be shy about asking for a referral to a gastroenterologist or ask your gastroenterologist for a referral to a surgeon. It's, it's always worth at least having a conversation and looking at your data and situation in particular and, seeing if that's something that could be a benefit to you.

Host: Well, thank you so much. This has been fascinating and educational. Thanks for sharing your expertise.

Dr. Tyler Watson: Yeah. Thank you, Maggie. I enjoyed it and happy to come back.

Host: Great. We'll do another one on a different topic or a more detailed, some other aspect of it. Again, that's Dr. Tyler Watson. To find a physician, visit NovantHealth.org. For more health and wellness information from our experts, visit HealthyHeadlines.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

I'm Maggie McKay. Thanks for listening to Meaningful Medicine from Novant Health.