Anti-reflux Surgery

What is Anti-reflux Surgery?

The oesophagus is a muscular passage which carries food from the mouth to the stomach. The lower oesophagal sphincter (LES) is a circular band of muscles at the lower end of the oesophagus that acts as a barrier between the oesophagus and the stomach.

Gastroesophageal reflux disease (GERD) is a chronic disease that occurs when the lower oesophagal sphincter closes incompletely allowing the stomach contents to leak back or reflux into the oesophagus. It can cause heartburn, a burning sensation felt in the chest or throat when the refluxed stomach acid touches the lining of the oesophagus.

Laparoscopic Nissen Fundoplication is a minimally invasive form of anti-reflux surgery performed to restore the function of the lower oesophagal sphincter.

Indications of Anti-reflux Surgery

• GERD
• Hiatal hernia is a condition in which the stomach bulges up into the chest through an opening in the diaphragm.
• Chronic esophagitis (inflammation of the oesophagus)
• Failed conservative treatment measures such as medications and lifestyle modification.

Surgical procedure

Nissen Fundoplication can be performed surgically with a laparoscopic technique under general anaesthesia.

Laparoscope is a small fibre-optic viewing instrument made up of a tiny lens, light source and a video camera. The camera attached to the laparoscope displays the image of the abdomen on a monitor, allowing the surgeon to view the internal structures.

The surgeon makes small incisions in the abdomen. In one incision, the laparoscope is introduced to view the abdomen. Along with the laparoscope, a sterile solution is injected which expands the abdominal cavity, giving the surgeon a clear space to operate. The other portal is used for the insertion of surgical instruments to repair the leak of gastric acid. The surgeon then wraps the stomach around the oesophagus to prevent the acid from the stomach going back into the oesophagus. At the end of the procedure, incisions are closed with sutures.

The benefits of laparoscopy are smaller incisions, faster healing, a more rapid recovery, shorter rehabilitation period, and less scarring. It is often performed on an outpatient basis and the patient is able to return home on the same day.

It is much less traumatic to the muscles, ligaments and tissues than the traditional method of surgically opening the abdomen with long incisions (open techniques).

After the Surgery

Following the surgery, your surgeon may recommend that you follow certain measures for a successful outcome:

• Avoid lifting heavy objects and activities that put excessive pressure on the abdomen.
• Your doctor will prescribe medications to relieve pain.
• Keep the incision area clean and dry.
• Your surgeon will recommend that you drink liquids and eat only soft foods for 2-4 weeks following surgery.

Risks and Complications of Anti-reflux Surgery

Complications include stomach bloating, dysphagia (difficulty in swallowing), loosening of the wrap, and recurrence of the symptoms.

Talk to your doctor if you have concerns regarding anti-reflux surgery.