what is laparoscopic anitireflux Surgery?
Antireflux Surgery (also known as Fundplication) is the standard surgical method of treating gastro-oesophageal reflux disease.
Reflux disease is the result of acid refluxing from the stomach backup into the oesophagus. This causes Inflammation and pain(heartburn).Normally there is a barrier to acid reflux. Part of this barrier is the lower-most muscle of the oesophagus (called the lower oesophageal sphincter). Most Of the time this muscle is contracted,which closes off the oesophagus from the stomach.
In patients with reflux disease,the sphincter does not function normally.The Muscle is either weak or relaxes in appropriately.
Fundoplication is a surgical technique that strengthens the barrier to acid reflux when the sphincter does not function normally.
Who needs Antireflux Surgery?
The vast majority of patients with reflux disease responds well to appropriate acid suppressing drugs and do not need surgery. However, for a small group of patients surgery can be helpful. There are three main reasons patients wish to have surgery:
- Failure to respond satisfactorily to adequate doses of medication
- Intolerable side effects from medication
- A desire to free of long-term medication
What does surgery involve?
If the operation is being carried out for the first time, it is nearly always achieved using keyhole techniques (laparoscopic surgery). Compared to open surgery, which involves a larger incision, the laparoscopic method leads to a speedier recovery and less post operative pain.
The surgeon will make 3-4 small cuts in your abdomen and insert instruments to carry out the operation. A harmless gas (Carbon Dioxide) is used to inflate your abdomen to make space for the operation to be performed. This will disperse naturally after the operation.
Most patients have hiatus hernia associated with their reflux disease and repair of this hernia is undertaken at the same time as antireflux surgery. The hernia sac is pulled down from the chest and stitched so that it remains within the abdomen. Additionally the opening in the diaphragm, through which the oesophagus passes from chest into abdomen is tightened.
During the procedure the part of the stomach that is closet to the entry of the oesophagus (the fundus of stomach) is gathered, wrapped and stitched around the lower end of the oesophagus. This procedure increases the pressure at the lower end of the oesophagus and thereby reduces acid reflux. This wrap (or fundoplication) produces a kind of one-way valve from the stomach into the oesophagus that we call the procedure antireflux surgery. The operation usually takes between 1 and 11/2 hours
You will have a general Anaesthetic – this means you will be asleep though out the operation. More details about the anaesthesia will be given to you at your Pre-Opearative assessment visit and by the anaesthetist on the day of surgery.
How long will I stay in hospital?
You will normally stay in hospital for 2-3 days.
What are the possible complications?
All operations carry the risk of problems and side effects.
Specific risks connected to this procedures are:
- Injury to the oesophagus, Stomach, blood vessels and nearby organs. These complications are rare and the surgeon may convert to open surgery to repair any damage
- 1% of patients (1 in 100) may need further corrective surgery to reduce persistent difficulty m swallowing and/or abdominal bloating
Common side effects
- The most common side effect is difficulty in swallowing. This is common immediately after operation and gradually improves. The amount of food you consume may be less and you may have to eat more slowly than you did before the operation
- Other common side effects are burping and increased wind (flatus) Most of these symptom settle with timeAre there any alternatives?
Antireflux surgery is the only treatment that can correct the anatomical abnormalities that lead to reflux. Surgery is generally recommended when other treatments have not been satisfactory. These include:
Acid suppressing drugs (such as Omeprazole or Lansoprazole) to reduce acid reflux (these work by reducing or neutralizing the acid in the stomach or making the stomach empty faster) However to control your symptoms these may need to be taken regularly for the rest of your life
Endoscopic techniques: These involve altering the oesophageal opening into the stomach through an endoscope. Currently these techniques are experimental and only performed as part of research trials
Lifestyle changes such as losing weight, avoiding foods that contribute to acid reflux and stop smoking
How long does it take to fully recover after Antireflux surgery?
Most patients do not have pain as such after laparoscopic surgery, rather just some abdominal and chest discomfort, many patients do experience some degree of discomfort in their shoulders after the procedure. As the surgery has been performed laparoscopically you will need to stay in the hospital for only 2-3 days.
Because of the lack of any wound pain by the time you go home you may well think you are able to act as though you have not had an operation, neverthless you will find that you get tired easily and you may even wish to have a sleep in afternoon for a few days. We also ask the patients to avoid heavy lifting for at least 2-3 weeks.
You can return to work as soon as you feel well enough. This will depend on how you are feeling and the type of work that you do. Typically you will need two to three weeks off work.
You should not drive for at least 7-10 days after surgery.
what can I eat after surgery?
Stage 1 – Clear Liquid Diet
Immediately after 6 hours after surgery Avoid carbonated drinks for 3-4 weeks
Stage 2-Soft Diet:
- Start soft diet day after surgery, continue at this stage for 3 days after surgery or as tolerated
- Limit gas forming/irritating foods like coffee, alcohol, onions, fatty and oily foods, Raw vegetables etc
- Avoid breads, biscuit, pancakes and toast
- No carbonated drinks
Stage 3 – Transition to regular diet
- Start about 3 days after surgery • Soft diet as above
- Introduce more challenging foods one at a time
- If they cause symptoms avoid them and reintroduce them at a later date
- Drop back to stage 2 as needed for bloating or difficulty swallowing
- No carbonated drinks for 3-4 weeks (soft drinks)
Stage 4 – Regular Diet
Start 3 to 6 weeks after surgery
Further Information / Question
If you have any questions or concern about the information,
Surgery Reception – (02692) 288215
Dr. G. M. Mannari – 9825046137
Dr. Apurva Patel – 9825754862