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If you suffer from
"heartburn" you
may benefit from LAPAROSCOPIC ANTI-REFLUX SURGERY to
treat this condition, technically referred to as gastroesophageal
reflux disease (GERD). This will explain to you:
1. What gastroesophageal reflux disease (GERD) is
2. Medical and surgical treatment options for GERD
3. How this surgery is performed
4. Expected outcomes
5. What to expect if you choose to have laparoscopic anti-
reflux surgery
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 accidently "back
up", from the stomach into the esophagus. Heartburn is
described as a harsh, burning sensation in the area in
between your ribs or just below your neck. The feeling
may radiate through the chest and into the throat and neck.
Many adults in the United States experience this uncomfortable,
burning sensation at least once a month. Other symptoms
may also include vomiting, difficulty swallowing and chronic
coughing or wheezing.
When you eat, food travels from your mouth to your stomach
through a tube called the esophagus. At the lower end of
the esophagus is a small ring of muscle called the lower
esophageal sphincter (LES). The LES acts like a one-way
valve, allowing food to pass through to the stomach. Normally,
the LES closes immediately after swallowing to prevent
back-up of stomach juices which have a high acid content.
GERD occurs when the LES does not function properly allowing
acid to flow back and burn the lower esophagus. This irritates
and inflames the esophagus, causing heartburn and eventually
may damage the esophagus.
Some people are born with a naturally weak sphincter (LES).
For others, however, fatty and spicy foods, certain types
of medication, tight clothing, smoking, drinking alcohol,
vigorous exercise or changes in body position (bending
over or lying down) may cause the LES to relax, causing
reflux, or the accidental back-up of acid. A hiatal hernia
(a common term for GERD) may be present in many patients
who suffer from GERD, but may not cause symptoms of heartburn.
GERD is generally treated in three progressive steps:
In many cases, changing diet and taking over-the-counter
antacids can reduce how often and how harsh your symptoms
are. Losing weight, reducing smoking and alcohol consumption,
and altering eating and sleeping patterns can also help.
If symptoms persist after these life style changes, drug
therapy may be required. Antacids neutralize stomach acids
and over-the-counter medications reduce the amount of stomach
acid produced. Both may be effective in relieving symptoms.
Prescription drugs may be more effective in healing irritation
of the esophagus and relieving symptoms.
Patients who do not respond well to lifestyle changes
or drug therapy, or who continually require medications
to control their symptoms, will have to live with their
condition or undergo a surgical procedure. Surgery is very
effective in treating GERD. However, until recently this
operation required a large abdominal incision resulting
in significant pain after surgery and a recovery period
of six weeks or greater.
Recently, this technique has been modified using laparoscopic
(minimally invasive) techniques that avoid the necessity
of a large abdominal incision.
Laparoscopic anti-reflux surgery (commonly referred to
as Laparoscopic Nissen Fundoplication) involves reinforcing
the "valve" between the esophagus and the stomach
by wrapping the upper portion of the stomach around the
lowest portion of the esophagus - much the way a bun fits
around a hot dog.
In a laparoscopic procedure, surgeons use small incisions
(1/4 to 1/2 inch) to enter the abdomen through canulas
(narrow tube-like instruments). The laparoscope, which
is connected to a tiny video camera, is inserted through
the small incision, giving the surgeon a magnified view
of the patient's internal organs on a television screen.
The entire operation is performed "inside" after the
abdomen is expanded by pumping gas into it.
Studies have shown that the vast majority of patients
who undergo the procedure are either symptom-free or have
significant improvement in their GERD symptoms.
The advantage of the laparoscopic approach is that it
usually provides:
- reduced postoperative pain
- shorter hospital stay
- a faster return to work
- improved cosmetic result
Although the operation is considered safe, complications
may occur as they may occur with any operation.
Complications during the operation may include:
- adverse reaction to general anesthesia
- bleeding
- injury to the esophagus, spleen or the
stomach
Complications after the operation may include:
- infection of the wound, abdomen, or blood.
- other less common complications may also
occur.
Your surgeon may wish to discuss these with you. (S)He
will also help you decide if the risks of laparoscopic
anti-reflux surgery are less than the risks of leaving
the condition untreated.
In a small number of patients the laparoscopic method
is not feasible because of the inability to visualize or
handle the organs effectively. When the surgeon feels that
it is safest to convert the laparoscopic procedure to an
open one, this is not a complication. It is sound surgical
judgement. Factors that may increase the possibility of
converting to the "open" procedure may include obesity,
a history of prior abdominal surgery causing dense scar
tissue, or bleeding problems during the operation. The
decision to perform the open procedure is a judgment decision
made by your surgeon either before or during the actual
operation. The decision to convert to an open procedure
is strictly based on patient safety.
Long-term side effects to this procedure are generally
uncommon.
Some patients develop temporary difficulty swallowing
immediately after the operation. This usually resolves
within one to three months after surgery. Occasionally,
these patients may require a simple procedure to expand
the esophagus (endoscopic dilation) or rarely re-operation.
The ability to belch and or vomit may be limited following
this procedure. Some patients complain of stomach bloating.
Rarely, some patients report no improvement in their symptoms.
To determine if you are a candidate for laparoscopic anti-reflux
surgery a thorough medical evaluation by your personal
physician is necessary. Some diagnostic tests may be necessary.
Your surgeon should discuss with you whether or not this
operation may be a benefit to you. After your surgeon reviews
with you the potential risks and benefits of the operation,
you will need to provide written consent for surgery.
After midnight the night before the operation no food
or liquids should be taken.
If you take medication on a daily basis, discuss this
with your surgeon as (s)he may want you to take some of
your medications on the morning of surgery with a sip of
water. If you take aspirin, blood thinners or arthritis
medication you need to discuss with your surgeon the proper
timing of discontinuing these medications before your operation.
You usually arrive at the hospital the morning of the
operation.
A qualified medical staff member will place a small needle/catheter
in your vein to dispense medication during surgery.
Often pre-operative medications are necessary.
You will be under general anesthesia - asleep - during
the operation which may last several hours.
Following the operation you will be sent to the recovery
room until you are fully awake.
Most patients stay in the hospital the night of surgery
and may require additional days in the hospital.
Patients are encouraged to engage in light activity while
at home after surgery.
Post operative pain is generally mild although some patients
may require pain medication.
Usually, anti-reflux medication is not required after
surgery.
Diet after surgery beginning will consist of liquids followed
by gradual advance to solid foods. No bread or meat should
be eaten for the first two weeks. You should ask your surgeon
about dietary restrictions immediately after the operation.
You will probably be able to get back to your normal activities
within a short amount of time. These activities include
showering, driving, walking up stairs, lifting, work and
sexual intercourse.
If you have prolonged soreness and are getting no relief
from the prescribed pain medication, you should notify
your surgeon. You should call and schedule a follow-up
appointment within 2 weeks after your operation.
Be sure to call your doctor if you develop any of the
following:
- Persistent fever
(over 100oF)
- Bleeding
- Increased abdominal swelling
or pain
- Persistent nausea or vomiting
- Chills
- Persistent cough or shortness
of breath
- Difficulty swallowing
that doesn't go away within a few weeks
- Drainage from any incision
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