Gastroesophageal Reflux Surgery

Gastroesophageal reflux surgery / Hiatus hernia repair/ Laparoscopic anti-reflux surgery

Gastroesophageal reflux disease (GERD) occurs when the sphincter muscle at the lower end of your esophagus relaxes at the wrong time, allowing stomach acid to back up into your esophagus. This can cause heartburn and other signs and symptoms. This backwash (acid reflux) can irritate the lining of your esophagus. Many people experience acid reflux from time to time. GERD is mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week. Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications. But some people with GERD may need stronger medications or surgery to ease symptoms.

Symptoms

Common signs and symptoms of GERD include:

  • A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
  • Chest pain
  • Difficulty swallowing
  • Regurgitation of food or sour liquid
  • Sensation of a lump in your throat

If you have night time acid reflux, you might also experience:

  • Chronic cough
  • Laryngitis
  • New or worsening asthma
  • Disrupted sleep

Conditions that can increase your risk of GERD include:

  • Obesity
  • Bulging of the top of the stomach up into the diaphragm (hiatal hernia)
  • Pregnancy
  • Connective tissue disorders, such as scleroderma
  • Delayed stomach emptying

Factors that can aggravate acid reflux include:

  • Smoking
  • Eating large meals or eating late at night
  • Eating certain foods (triggers) such as fatty or fried foods
  • Drinking certain beverages, such as alcohol or coffee
  • Taking certain medications, such as aspirin

Complications of GERD

Over time, chronic inflammation in your esophagus can cause:

  • Narrowing of the esophagus (esophageal stricture). Damage to the lower esophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing.
  • An open sore in the esophagus (esophageal ulcer). Stomach acid can wear away tissue in the esophagus, causing an open sore to form. An esophageal ulcer can bleed, cause pain and make swallowing difficult.
  • Precancerous changes to the esophagus (Barrett’s esophagus). Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associated with an increased risk of esophageal cancer.

Laparoscopic anti-reflux surgery

Over time, chronic inflammation in your esophagus can cause:
Laparoscopic anti-reflux surgery for GERD may involve a procedure to reinforce the lower esophageal sphincter, called fundoplication. A fundoplication is done through key-hole surgery and involves correcting the acid control mechanisms. This is usually in two parts – firstly bringing the stomach back down into the normal position and secondly repairing the hole in the diaphragm (the hiatus hernia) and anchoring the stomach in the new position. There are various ways to anchor the stomach – complete wrap (Nissen fundoplication), partial wrap (Toupet fundoplication) and anterior wrap (anterior fundoplication). This decision is determined at the time of surgery and in response to your particular symptoms. The surgery is considered to be safe and very effective but usually requires several weeks of puréed diet following surgery as there is often significant swelling. After this time, diet will return to normal.

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