What is Gastric Reflux Surgery?
Gastric reflux surgery, also known as anti-reflux surgery, is a surgical procedure to treat
gastro-oesophageal reflux disease (GORD). Gastric reflux surgery generally includes fundoplication, a technique to recreate lower oesophageal sphincter pressure by wrapping the fundus of the stomach around the oesophagus in the abdomen.
It involves repairing the malfunctioning lower oesophageal sphincter (LES), which prevents the backward flow of stomach acid into the oesophagus. By restoring the normal function of the LES, gastric reflux surgery aims to alleviate the symptoms and complications associated with GORD.
Fundoplication Surgery for GORD
If conservative treatment options fail to resolve your GORD, your doctor may recommend a surgical procedure called Fundoplication. Fundoplication surgery reinforces the lower oesophageal sphincter’s ability to close and helps to prevent gastro-oesophageal reflux from occurring. This surgery can be performed laparoscopically through tiny incisions in the abdomen in most people.
Benefits of Fundoplication Laparoscopy
Laparoscopy is much less traumatic to the muscles and soft tissues than surgically opening the abdomen with long incisions. It is also associated with a shorter hospital stay, less postoperative pain and faster recovery.
Who is Suitable for Gastric Reflux Surgery?
Gastric reflux surgery is typically recommended for individuals who experience chronic GORD symptoms unresponsive to conservative treatments, such as lifestyle modifications and medication. Suitable candidates for gastric reflux surgery may include those with severe symptoms, complications of GORD (such as Barrett's oesophagus), or individuals who wish to reduce their reliance on long-term medication.
Benefits of Gastric Reflux Surgery
Gastric reflux surgery offers several benefits for individuals with chronic GORD, including:
- Relief from GORD Symptoms: Alleviate symptoms such as heartburn, regurgitation, chest pain, and difficulty swallowing, providing significant relief and improving quality of life.
- Reduced Medication Dependence: For individuals who rely on long-term medication to manage GORD, surgery may reduce or eliminate the need for daily medication, offering a more sustainable solution.
- Improved Oesophageal Health: By preventing the backward flow of stomach acid into the oesophagus, gastric reflux surgery can help prevent complications such as oesophageal inflammation, ulcers, and the development of Barrett's oesophagus.
Types of Gastric Reflux Surgery
There are different types of gastric reflux surgery procedures available, including:
- Laparoscopic Nissen Fundoplication:
The most common and widely performed procedure. It involves wrapping the upper part of the stomach (fundus) around the lower oesophagus to reinforce the LES and prevent acid reflux.
- Laparoscopic Toupet Fundoplication: Similar to the Nissen fundoplication, this procedure also involves wrapping a portion of the stomach around the lower oesophagus. However, it is a partial wrap that provides a looser valve, allowing for better preservation of swallowing function.
Alternative Options for Gastric Reflux Surgery
In addition to gastric reflux surgery, alternative treatment options are available for managing GORD. These may include:
- Medication:
Prescription and over-the-counter medications, such as proton pump inhibitors (PPIs) and H2 receptor blockers, can help reduce stomach acid production and alleviate GORD symptoms. However, they provide temporary relief and may not address the underlying cause.
- Lifestyle Modifications: This may involve weight loss, avoiding trigger foods, eating smaller meals, maintaining an upright posture after meals, and quitting smoking.
Preparation Before Gastric Reflux Surgery
Before undergoing gastric reflux surgery, several preparatory steps are necessary. These may include:
- Medical Evaluation:
A thorough medical evaluation will assess the individual's overall health, determine the severity of GORD, and rule out any underlying conditions.
- Pre-operative Instructions: Patients will receive specific instructions regarding dietary restrictions, medication management, and lifestyle modifications in the weeks leading up to the surgery. It is crucial to follow these instructions closely to ensure optimal surgical outcomes.
Fundoplication Procedure
Fundoplication is performed under general anaesthesia. Steps involved in the Fundoplication procedure include:
- Your surgeon makes five small incisions in the upper abdomen, inserting a telescope and several other instruments into the abdomen. The procedure is done by watching a monitor.
- With the images from the laparoscope as a guide, your surgeon wraps the upper part of the stomach (called the fundus) around the lower oesophagus to create a valve, suturing it in place.
- The hole in the diaphragm through which the oesophagus passes is then tightened with sutures.
- The laparoscope and other instruments are removed, and the gas is released.
- The tiny incisions are then closed.
What to Expect After Gastric Reflux Surgery?
After gastric reflux surgery, patients can expect the following:
- Hospital Stay:
Most patients can expect to stay in the hospital for a day or two after the surgery to monitor their recovery and manage postoperative discomfort.
- Diet Progression: You will start with a liquid or soft diet and gradually transition to solid foods as guided by your surgeon or dietitian.
- Recovery and Healing: It may take several weeks for the incisions to heal completely, and you should follow your surgeon's instructions regarding activity restrictions and wound care.
Gastric Reflux Surgery Care Plan
Wound Care
- Ensure it is covered with waterproof dressings so you can shower.
- They should be removed after seven days.
Pain Management
- You may feel soreness around the incision areas. As (during the procedure), the abdomen was distended with gas.
- Your surgeon may prescribe pain medicine or recommend non-steroidal anti-inflammatory drugs (NSAIDs) for the first few days to keep you comfortable.
- You may experience discomfort in the abdomen, chest, or shoulder area for several days.
Activity
- Shortly after surgery, you can gradually resume your daily activities.
- You are encouraged to start walking as early as possible to reduce the risks of blood clots and pneumonia.
- You are advised not to lift heavy objects for 8 to 12 weeks.
Work
- You can get back to work in 2 to 3 weeks.
Contact your doctor immediately if you have a fever, chills, increased pain, bleeding or fluid leakage from the incisions, chest pain, shortness of breath, leg pain or dizziness.
Gastric Reflux Surgery Prognosis
The outcome of treatment varies from person to person. Surgery is beneficial in approximately 90% of patients. Many patients who have suffered for years from heartburn and required medication to control the symptoms find that all symptoms are alleviated as soon as they awake from surgery and no longer need medication. Some may experience mild symptoms.
While treatment can be very successful for others, most people respond well to lifestyle changes and medications. However, relapse is very common after cessation of medications, so the condition does require maintenance. Surgery is recommended when medications fail to resolve symptoms, or you prefer not to take them.
Gastric Reflux Surgery Risks
As with any surgical procedure, gastric reflux surgery carries potential risks and complications, including infection, bleeding, adverse reactions to anaesthesia, damage to surrounding structures, and post-operative discomfort. Fundoplication may involve certain side effects. These can include trouble swallowing, inability to burp or vomit, bloating and passing more wind.
These side effects do not occur in everyone. Patients should discuss these risks with their surgeons and be aware of the potential complications.