Anti-Reflux Surgery2022-10-31T21:41:22+10:30

Anti-Reflux Surgery

Whilst minor degrees of gastro-oesophageal reflux are common in the general population, the majority of patients can be managed effectively with a combination of medications and lifestyle changes. People who continue to have reflux symptoms and or conditions secondary to reflux despite maximal medical therapy maybe candidates for anti-reflux surgery.

There are also some patients who find it difficult to remember to take their medications or who would rather not take medications for the rest of their lives. If suitable these patients maybe candidates for anti-reflux surgery. Some patients have an associated hernia of their stomach into the chest, known as a Hiatus hernia, which is repaired at the same time as the anti-reflux operation.

The aim of anti-reflux surgery is to restore the barrier or valve between the stomach and the oesophagus. This is normally achieved by wrapping the top of the stomach (the fundus) around the lower part of the oesophagus. If the stomach is wrapped completely around the stomach this is known as a Nissen fundoplication. There are variations of this where the stomach is only partially wrapped either across the front (anterior fundoplication) or behind the oesophagus (Toupet).

Partial wraps are used where there is concern over the motor function of the oesophagus, which can potentially lead to swallowing difficulties if a full wrap is performed. Prior to surgery patients will generally undergo testing of the motor function of the oesophagus (oesophageal manometry) to identify patients where this maybe an issue.

Following anti-reflux surgery swelling associated with the surgery results in a temporary degree of swallowing difficulties in virtually all patients. Because of this swelling patients will need to modify their diet towards softer and pureed foods for the first 6 weeks following their surgery.

It is important to realise that in most patients swallowing difficulties are temporary and that in the long run most patients can tolerate a normal diet. It is also worth remembering that many patients who have swallowing difficulties prior to surgery actually have much improved swallowing once their reflux is controlled. More detailed dietary advice will be supplied prior to discharge.

Advantages

• Performed laparoscopically

• Fast recovery and short hospital stay

• 70-80 percentage of patients no longer require medication to control reflux symptoms

Heartburn / Reflux Information

There are many names, and acronyms to describe what most people commonly know as heartburn or reflux. The most common is gastro-oesophageal reflux disease, which is often shortened to either GORD or GERD depending on whether you live in the USA or not. Reflux is normally prevented by a muscular sphincter at the lower end of the oesophagus, which acts as a valve to prevent the contents of the stomach especially gastric acid refluxing up into the oesophagus.

Heartburn, a burning sensation typically felt behind the breast bone is the most common symptom of gastro-oesophageal reflux disease, but other symptoms include regurgitation with a bitter taste in the back of the mouth, and difficulties with swallowing. Less commonly reflux may aggravate the upper airways causing problems such as asthma or cause hoarseness of the voice.

In most cases of reflux there is an underlying weakness of the sphincter at the lower end of the oesophagus, so that the barrier preventing the movement or reflux of the contents of the stomach, which includes gastric acid, is greatly impaired. Weakness of the oesophageal sphincter maybe made worse by food or drinks containing caffeine such as coffee and chocolate, and is also impaired by smoking.

Obesity an ever increasing problem also worsens reflux. Acid, which enters the oesophagus, can damage the lining of the oesophagus, causing inflammation, and even ulceration when the damage is particularly severe. In response to this damage the lining of the oesophagus may even change so that it is more resistant to the effects of acid. This change in the lining is known as Barrett’s oesophagus and whilst it may be seen as an adaptation the down side is that it does carry a small chance of turning cancerous.

The effects of reflux can be seen on endoscopy. A procedure where a flexible scope is passed through the mouth in to the oesophagus, stomach and first part of the small intestine. This is normally done whilst the patient is sedated and allows direct visualization of the lining of the oesophagus to detect changes such as inflammation and ulceration. Biopsy of any areas of concern may also be taken. Other tests which maybe used to diagnose reflux include oesophageal manometry and 24 hour Ph monitoring, these test are usually performed before contemplating anti-reflux surgery.

Mild or occasional reflux is extremely common in the general population and most patients with such symptoms can be managed with simple antacids along with lifestyle changes such as weight loss and avoiding food or fluids, which aggravate reflux symptoms. Other patients with more persistence symptoms may require suppression of stomach acid production by medications. A small group of patients despite medications will still have severe symptoms, these patients may be candidates for anti-reflux surgery.

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