What is Gastroesophageal Reflux?
Although “heartburn” is often used to describe a variety of digestive problems, in medical terms, it is actually a symptom of gastroesophageal reflux disease. In this condition, stomach acids reflux or “back up” from the stomach into the esophagus. Heartburn is described as a harsh, burning sensation in the area in between patients ribs or just below patientr neck. The feeling may radiate through the chest and into the throat and neck. Many adults experience this uncomfortable, burning sensation at least once a month. Other symptoms may also include vomiting, difficulty swallowing and chronic coughing or wheezing.
What Causes GERD?
When patient eat, food passes from mouth, through a swallowing tube called the esophagus, and then into the stomach. Located at the lower end of the esophagus is functional valve called the lower esophageal sphincter (LES). The LES is a one-way valve that permits food to pass to the stomach. Normally, the valve closes after the food has reached the stomach and prevents stomach acids from backing up or “refluxing” back into patient’s esophagus. Some reflux is normal and usually clears. GERD occurs when the valve fails and stomach acids flow back and burn the lower esophagus. The reflux persists over a period of time; the esophagus becomes irritated and inflamed, causing heartburn and sometimes damage to the esophagus.
Who is suitable for Reflux surgery?
Before surgery is advised it is very important that the diagnosis is confirmed beyond doubt. Making the diagnosis usually requires viewing the oesophagus and stomach by gastroscopy (a flexible video camera), taking samples of the oesophageal lining and excluding other causes of chest pain such as heart disease or spasm of the oesophagus. Sometimes it is necessary to use special tests such as oesophageal pH (acid) testing where an electrode is positioned in the lower oesophagus for a full day and the severity of reflux is measured. Surgery is usually only recommended if medications have already been tried and are not effective or a preference to avoid medications is indicated.
What to expect before Reflux Surgery:
- After surgeon reviews with patient the potential risks and benefits of the
operation, patient will need to provide written consent for surgery.
- Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on patient’s age and medical condition.
- Surgeon may request that patient completely empty colon and cleanse patient’s intestines prior to surgery. Patient may be requested to drink clear liquids, only, for one or several days prior to surgery.
- It is recommended that patient shower the night before or morning of the operation.
- After midnight the night before the operation, patient should not eat or drink anything except medications that surgeon has told patient are permissible to take with a sip of water the morning of surgery.
- Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
- Diet medication should not be used for the two weeks prior to surgery.
Procedure of Reflux Surgery:
The aim of surgery is to permanently control the reflux of acid from the stomach into the oesophagus by strengthening the lower oesophageal sphincter. Three main steps achieve this: 1) the stomach is repositioned in its normal location below the diaphragm. 2) The defect in the diaphragm is closed. 3) A portion of the stomach is used to encircle the lower oesophagus to strengthen the lower oesophageal sphincter (Fundal wrap).Traditionally this operation was performed using a large abdominal incision. While this approach was usually successful, the pain caused by the incision, meant that patient spent up to a week in hospital and were unable to work for at least six weeks.
Modern technology has made it possible to perform this same operation without the large incision using a video camera called a laparoscope. In most cases five small incisions are used. Two of these are 10 mm in size and three are 5 mm in size. All the operating is done through these small cuts. The result of this less invasive surgery is that patient is able to return home after only one or two nights in hospital and are often back to work within a week. This new approach is called a “Laparoscopic Nissen Fundoplication” and is becoming increasingly popular for long-term control of gastroesophageal reflux.
What to expect after Reflux Surgery?
- Engage in light activity at home.
- Experience mild postoperative pain and having pain medication available as needed.
- Feeling some tightness from swelling of the esophagus and some difficulty swallowing may happen. This should gradually go away within 2 months.
- Not having to take reflux medications after surgery.
- Having a modified diet starting with liquids followed by gradually taking solid foods. Eat small meals frequently and chew food well. Ask physician about dietary restrictions after surgery. Patient may be asked to eat foods such as soup, gelatin, bananas, pudding, or yogurt because they are easy to swallow and digest. Don’t gulp to avoid gas bloat and make it easier for swallowing. Patient may be asked to avoid carbonated drinks for 3-4 weeks.
- Resume normal activities such as showering, stair climbing, working, lifting, driving and having sexual intercourse after discussing these with physician.
- Call and schedule a follow-up appointment within one to two weeks after surgery. Schedule any additional follow-up appointments.
- Have any stitches removed depending upon the type physician uses.
Benefits of Reflux Surgery:
About 90% of patients are free of heartburn after the operation. It also cures GERD-induced asthmatic or respiratory symptoms in up to 85% of patients. The procedure may enhance stomach emptying, and it improves peristalsis in about half of patients.
Reflux Surgery in India:
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