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Anti-Reflux Disease
Anti-Reflux Surgery (Add)

Anti-reflux surgery is a treatment for acid reflux, also known as GORD (gastroesophageal reflux disease). GORD is a condition in which food or stomach acid come back up from your stomach into the oesophagus. The oesophagus is the tube from your mouth to the stomach.

Reflux often occurs if the muscles where the oesophagus meets the stomach do not close tightly enough. A hiatal hernia can make GORD symptoms worse. It occurs when the stomach bulges through this opening into your chest.

Symptoms of reflux or heartburn are burning in the stomach that you may also feel in your throat or chest, burping or gas bubbles, or trouble swallowing food or fluids.

Description

The most common procedure of this type is called fundoplication. In this surgery, we will:

First repair the hiatal hernia, if one is present. This involves tightening the opening in your diaphragm with stitches to keep your stomach from bulging upward through the opening in the muscle wall. Some surgeons place a piece of mesh in the repaired area to make it more secure. Wrap the upper part of your stomach around the end of your oesophagus with stitches. The stitches create pressure at the end of your oesophagus, which helps prevent stomach acid and food from flowing up from the stomach into the oesophagus. Surgery is done while you are under general anaesthesia, so you are asleep and pain-free. Surgery most often takes 2 to 3 hours. Most of my surgical approach is Laparoscopic (key hole)

LAPAROSCOPIC REPAIR

This will involve making 3 to 5 small cuts in your belly. A thin tube with a tiny camera on the end is inserted through one of these cuts. Surgical tools are inserted through the other cuts. The laparoscope is connected to a video monitor in the operating room. I will do the repair while viewing the inside of your belly on the monitor. TI might need to switch to an open procedure in case of problems.

Why the Procedure is Performed

Before surgery is considered, your health care provider will have you try:

(1) Medicines such as H2 blockers or PPIs (proton pump inhibitors)
(2) Lifestyle changes
(3) Surgery to treat your heartburn or reflux symptoms may be recommended when:


  • Your symptoms do not get much better when you use medicines.
  • You do not want to keep taking these medicines.
  • You have more severe problems in your oesophagus, such as scarring or narrowing, ulcers, or bleeding.
  • You have reflux disease that is causing aspiration pneumonia, a chronic cough, or hoarseness.
  • Anti-reflux surgery is also used to treat a problem where part of your stomach is getting stuck in your chest or is twisted. This is called a para-oesophageal hernia.
Risks

(1) Reactions to medicines
(2) Breathing problems
(3) Bleeding, blood clots, or infections
(4) Damage to the stomach, oesophagus, liver, or small intestine. This is very rare.
(5) Gas bloat. This is when the stomach overfills with air or food and you are unable to relieve the pressure by burping or vomiting. These symptoms slowly get better for most people.
(6) Pain and difficulty when you swallow. This is called dysphagia. In most people, this goes away during the first 3 months after surgery.
(7) Return of the hiatal hernia or reflux.

Before the Procedure You may need the following tests:

Blood tests (complete blood count, electrolytes, or liver tests). Oesophageal manometry (to measure pressures in the oesophagus) or pH monitoring (to see how much stomach acid is coming back into your oesophagus). Upper endoscopy. Almost all people who have this anti-reflux surgery have already had this test. If you have not had this test, you will need to do it. X-rays of the oesophagus using a Barium dye.

On the day of your surgery:

Follow the instructions about when to stop eating and drinking. Take the drugs your doctor told you to take with a small sip of water.

After the Procedure

Most people who have laparoscopic surgery can leave the hospital within 1 to 2 days after the procedure. You may need a hospital stay of 2 to 6 days if you have open surgery. Most people can return to normal activities in 4 to 6 weeks

Outlook (Prognosis)

Heartburn and other symptoms should improve after surgery, success rate is about 85%. Some people still need to take drugs for heartburn after surgery or experience difficulty in swallowing.

You may need another surgery in the future if you develop new reflux symptoms or swallowing problems. This may happen if the stomach was wrapped around the oesophagus too tightly, the wrap loosens, or a new hiatal hernia develops.