ANTI-REFLUX DISEASE

Anti-reflux Surgery

When the prescribed medicine is not producing the expected result, Anti-reflux surgery is carried out to treat acid reflux, also known as GERD (Gastroesophageal Reflux Disease). GERD is a medical condition where the food or stomach acid comes back into the esophagus-a tube connected from the mouth to the stomach. The reflux condition is often found because of a closure at the meeting juncture of the stomach and esophagus. A hiatal hernia, making the GERD condition worse, occurs when the upper side of the stomach bulges through the large muscle, resulting in a separation of the abdomen and chest. The reflux or heartburn is symptomized through the uncomfortable burning in the stomach that may also be felt in the throat or chest, gas bubbles or burping, or trouble in swallowing fluids.

• The most common operational procedure which is also known as fundoplication, will take care of:
  Mending the hiatal hernia. This procedure also entails tightening the gap in the diaphragm with stitches, keeping the stomach from bulging upwards via the opening in the muscle wall. Surgeons will then install a piece of mesh in the operated area, making it more secure.
• Stitching the upper portion of the stomach with the end of the esophagus where the meeting of these organs lies. These stitches invent the pressure at the ending point of the esophagus, which assists in preventing the stomach acid and food from traveling through the stomach into the esophagus.

In executing the painless surgery, the patient is injected with general anesthesia.The surgeon will adopt a variety of techniques to perform the surgery, which generally takes two to three hours.

Open Repair and Laparoscopic Repair are the most common ones:

Open Repair Procedure

After performing a larger surgical cut in the belly, a tube can be inserted into the stomach, which passes through the abdomen, putting the stomach wall well in place. This inserted tube will be removed within a week.

A Step-Wise Procedural Job of Laparoscopic Repair

• Upon making three to five small cuts in the belly, a thin tube equipped with a tiny camera at the end will be placed into the stomach through one of these cuts.
• Surgical tools of the laparoscope will be inserted through one of the other cuts. This machine would be connected with a video display in the operating theatre.
• The surgeon will perform the surgery, watching the video monitor of the stomach through the inserted tiny camera.
• If an urgency crops up on account of the complication of the problem, the surgeon may switch to an open repair surgery.

Surgery for “Heartburn”

If a person feels “Heartburn,” ranging from moderate to severe, it is recommended to undergo the treatment of Laparoscopic Antireflux Surgery, as advised by a surgeon doctor. This piece of writing will expound the medical condition of GERD, its potential causes, the procedural tediousness of the surgery along with its anticipated results, and patient expectations when they choose Laparoscopic Surgery as well as its treatment.

An Overview of Gastroesophageal Reflux Disease

Even though “Heartburn” is used to spell out an array of digestive issues, it is symptomized as a condition of Gastroesophageal Reflux disease. In this prevailing condition, stomach acid goes back into the tube, known as the esophagus. This acid can create the irritation of the lining of the esophagus, resulting in the condition of GERD.
A harsh and burning sensation in the area placed in between ribs or just below the neck symptomizes as heartburn. It is felt through the chest and into the throat and neck. Other symptoms of this sensation are vomiting, regurgitation, the persistent problems in swallowing, or chronic coughing or wheezing.
According to a survey, many adult Americans in the United States of America encounter this burning sensation at least once a month.

Potential Reason for GERD

Through the process of eating, food reaches the stomach from the mouth, passing through the esophagus. At the lower end of the esophagus, there is a ring-like muscle, which is known as the lower esophageal sphincter (LES). It functions as a one-way valve, permitting the food to go through the stomach and closes promptly after swallowing to prevent back-up of the stomach juices. This stomach juice comprises of the high acid content into the esophagus. The GERD condition happens to occur when the LES function becomes upset, or doesn’t function properly, allowing acid to come back and upset the lower esophagus. The failure of the LES function irritates the passage of the esophagus, causing heartburn and eventually damaging the esophagus. Changes in the types of cells in the lining of the lower esophagus have been observed in a couple of patients who develop an esophageal condition. This condition is also known as Barrett’s esophagus. This persistence of this condition prompts the risk of developing cancer of the esophagus.

Contributors to GERD

At birth, many people default with a naturally weak sphincter (LES). Others have a habit of eating junkie and spicy food on a regular basis, taking certain types of medication, smoking, consuming excessive alcohol in various forms, exercising vigorously or changing in body posture such as bending over or lying down. These are various reasons for reflux. Many patients suffering from GERD also develop hiatal hernia. A hiatal hernia is a medical condition wherein the upper segment of the stomach forces up through the diaphragm and into the region of the chest. The diaphragm is a large muscle that is placed between the abdomen and chest. This phenomenon acts as an active medium for the development of acid influx. GERD, along with hiatal hernia, are operated simultaneously.

Medical and Surgical Treatment Options

1. Changes in Lifestyle: In numerous cases, replacing a more nutritious diet from fatty and spicy edible materials can reduce the severance and harshness of this disease. Losing weight, giving up or lessening smoking and alcohol, and correcting the sleeping patterns can help reach results.
2. Drug Therapy: If the problem persists, regardless of the changes in lifestyle, drug medication is the next step. Antacids are to be used in the pursuit of neutralizing the stomach acids, and over-the-counter medications help lessen the already produced amount of stomach acids. This form of therapy will be effective in healing the disease. However, prescriptive medication may be more effective in healing the irritation of the esophageal condition. Your doctor and your surgeon should be your point of contact when considering this therapy.
3. Surgery: Many patients who are non-responsive despite lifestyle changes and medications undergo a surgical treatment. Surgery is the most effective and corrective course of action in treating GERD patients. The most common surgery to treat GERD patients is fundoplication, usually named as a Nissen fundoplication. This procedure was named after the surgeon who pioneered the operational procedure in the late 1950s. A fundoplication operation comprises of repairing hiatal hernia in case of its presence and wrapping up the top part of the stomach around the end of the esophagus. It paves the way to help the lower esophageal sphincter by recreating the one-way valve in order to prevent acid reflux. This procedure can be executed in two different ways:

• • Using a long incision over the region of the upper abdomen
  • Using several small incisions by utilizing the invasive techniques known as laparoscopic surgery

Several Benefits of The Laparoscopic Technique

• Less postoperative pain
• A comparative shorter stay in the hospital
• A much faster resumption towards work and life
• An improved cosmetic result

Are you the one who is going to be treated through the laparoscopic technique?

Regardless of the numerous benefits of laparoscopic surgery, it may not be the best option to many patients when it comes to the benefits of this surgery. Upon obtaining a profound medical examination by a qualified laparoscopic doctor in consultation with the primary care physician or Gastroenterologist, it is necessary to assess if this technique is deemed appropriate for you.

The Nitty-gritty of Laparoscopic Surgery

What is expected before the Laparoscopic Anti-reflux Surgery?

• After a thorough review by a surgeon in the pursuit of educating patients about the potential risks and various benefits of this surgery, the patient needs to submit a written consent
• Pre-operative preparations consisting of blood work, medical check-ups, as well as a chest X-ray and EKG depending on the patient’s age
• In some cases, a couple of additional tests can be done before the day of the surgery
• The surgeon can suggest these tests based on the medical history of an individual
• It is advised to take a nice shower on the eve or the morning of the surgery
• Medicine such as aspirin, blood thinners, anti-inflammatory (arthritis medications), and medicines related to Vitamin E should be discontinued on an interim basis from several days to a week before the surgery
• The diet of St. John Wort for medication objectives should not be practiced, and it should be discontinued two weeks earlier the surgery
• Last but not least, quitting smoking or renouncing this bad habit would be called upon at home in case of any such urgency pops up

What to expect on the Surgery day?

•  The patient should arrive at the hospital on the eve or the morning of the operation day
• A qualified medical staff member will penetrate a small needle/catheter to transport the medicine during the ongoing surgery
• Post-op, it has been observed quite often that preoperative medications are compulsory 
• The patient will be operated under the effect of the general anesthesia as the operation takes several hours
• After the successful operation, the patient will be shifted to a recovery room
•  Most patients spend the night or the following couple of days after the surgery healing  

How is this surgery executed?

• Laparoscopic anti-reflux surgery, also known as Laparoscopic Nissen Fundoplication, comprises of remedying the “valve” at the juncture of the esophagus and the stomach 
• Through this surgery, the surgeon wraps up the upper portion of the stomach around the lowest portion of the esophagus
• In executing the laparoscopic procedure, the surgeon, using small incisions which are in the range of ¼ to ½ inches, enters the abdomen. Trocars, narrow tube-like equipment, are placed into the abdomen. The surgeon uses carbon dioxide in order to help the abdomen expand, providing the required space to see and work
• A tiny-camera connected with the laparoscope will be penetrated through one of the incisions. This caters to giving the magnified view of the patient’s internal organs over the display of the laparoscope machine to the surgeon, correcting the problem which was not possible through the medication
• The whole operation is done “inside” the abdomen of the patient. A variety of narrow instruments are used to pass through the trocars

What are the next steps if the operation can’t be completed by using the laparoscopic technique?

Laparoscopic surgery doesn’t work out well in a handful of cases, resulting in initiating the procedure of open surgery. This situation comes up when the surgeon is not able to handle or visualize the organs effectively. A couple of factors are responsible for this kind of unexpected situation. These are obesity, a history of earlier abdominal surgery prompting dense scar tissue, or bleeding issues during the laparoscopic surgery. The surgeon makes the judgment call to replace the laparoscopic surgery with open surgery either before the surgery or during the surgery when intricacy arises. The surgeon takes this call not because of any reinforcing complications but because the safety of the patient is top priority. This judgement call from converting laparoscopic surgery into an open surgery is based strictly on adhering to the safety norms of the patient.

Post-Surgery Engagements

•  Engaging in light physical activities is advised by the surgeon while staying at home
• Heavy lifting or participating in strenuous activities should be avoided for a short time
• Normally, post-operative pain is mild. In a handful of cases, painkillers are prescribed to alleviate the post-surgery pain for a short duration
• Post-surgery, generally, a medication for anti-reflux is not prescribed
• On an interim basis, most surgeons outline a dietary plan for their patients, starting with liquids, gradually followed by solid food. It is advised to ask the surgeon about dietary restrictions if any, immediately after the operation
• Within a short span of time, the patient will resume the normal activities of his/her life such as showering, driving, walking up stairs, lifting, working, and engaging in sexual intercourse
• Call the surgeon for scheduling a follow-up appointment within two weeks of the operation

Are there any side-effects to this surgery?

Several studies have discovered that the plethora of patients who undergo this surgery are either symptom-free or have striking progress in their GERD. However, here is a concise rundown of a few temporarily milder issues:

• A small number of patients feel difficulty when swallowing, immediately after the surgery. However, this difficulty relieves itself within two to three months
•  Sporadically, a small number of patients may need a procedural stretch of the esophagus (endoscopic dilation). A patient is re-operated on in very rare cases
•  The patient’s ability to belch or vomit may be limited following the procedure. At times, a couple of patients report stomach bloating
• Rarely, a handful of patients show no improvement.  At times, reflux symptoms can return after a couple of months or years following the surgery

Anticipated Outcome

The occurrence of certain complications

Despite this operation being safe, unexpected complications can pop up; as they may happen with any other operation:

• Reaction to the general anesthesia
• Bleeding
• Sustaining injury to the esophagus, internal organs, spleen, liver or stomach
•  Infected wound, blood or abdomen
• Other less common intricacies can also happen

The surgeon will educate the patient about these above complications. They will make you understand if the laparoscopic anti-reflux surgery is less risky than non-operative management.

Time to call your doctor

Be sure to speak with your doctor or surgeon if you develop the following symptoms:

• Constant fever over 101 degrees F (39 C)
•  Failure to eat or drink
• Persistent cough or breathlessness
• Chills
•  More abdominal swelling
•  Nausea or vomiting with persistent nature
•  Redness over the region of the incisions that get worse or bigger
• Purulent drainage (pus) from any of the incisions
•  Unrelievable pain regardless of medication

This writing piece is deliberated to present a general overview of GERD and laparoscopic anti-reflux surgery. Its purpose is not an alternative to professional medicare or a discussion that is held between the patient and their doctor about the need for performing the laparoscopic anti-reflux surgery. Specific recommendations for carrying out this laparoscopic anti-reflux vary among healthcare professionals.