In addition to weight loss surgery we perform minimally invasive general surgery procedures for diseases involving the stomach, gallbladder, colon as well as surgery for reflux, hernias and other gastrointestinal diseases. If you need surgery for any of these conditions please call to schedule a consultation.
Laparoscopic Anti-Reflux (GERD) Surgery
SURGERY FOR "HEARTBURN"
If you suffer from "heartburn" your surgeon may have recommended LAPAROSCOPIC ANTI-REFLUX SURGERY to treat this condition, technically referred to as gastroesophageal reflux disease (GERD). This page will explain to you:
1.What gastroesophageal reflux disease (GERD) is
2.Medical and surgical treatment options for GERD
3.How this surgery is performed
5.What to expect if you choose to have laparoscopic anti-reflux surgery
WHAT IS GASTROESOPHAGEAL REFLUX DISEASE (GERD)?
Although "heartburn" is often used to describe a variety of digestive problems, in medical terms, it is actually a symptom of gastroesophageal reflux disease. In this condition, stomach acids reflux or "back up" from the stomach into the esophagus. Heartburn is described as a harsh, burning sensation in the area in between your ribs or just below your neck. The feeling may radiate through the chest and into the throat and neck. Many adults in the United States experience this uncomfortable, burning sensation at least once a month. Other symptoms may also include vomiting, difficulty swallowing and chronic coughing or wheezing.
WHAT CAUSES GERD?
When you eat, food travels from your mouth to your stomach through a tube called the esophagus. At the lower end of the esophagus is a small ring of muscle called the lower esophageal sphincter (LES). The LES acts like a one-way valve, allowing food to pass through into the stomach. Normally, the LES closes immediately after swallowing to prevent back-up of stomach juices, which have a high acid content, into the esophagus. GERD occurs when the LES does not function properly allowing acid to flow back and burn the lower esophagus. This irritates and inflames the esophagus, causing heartburn and eventually may damage the esophagus.
WHAT CONTRIBUTES TO GERD?
Some people are born with a naturally weak sphincter (LES). For others, however, fatty and spicy foods, certain types of medication, tight clothing, smoking, drinking alcohol, vigorous exercise or changes in body position (bending over or lying down) may cause the LES to relax, causing reflux. A hiatal hernia (a common term for GERD) may be present in many patients who suffer from GERD, but may not cause symptoms of heartburn.
HOW IS GERD TREATED?
GERD is generally treated in three progressive steps:
1. LIFE STYLE CHANGES
In many cases, changing diet and taking over-the-counter antacids can reduce how often and how harsh your symptoms are. Losing weight, reducing or eliminating smoking and alcohol consumption, and altering eating and sleeping patterns can also help.
2. DRUG THERAPY
If symptoms persist after these life style changes, drug therapy may be required. Antacids neutralize stomach acids and over-the-counter medications reduce the amount of stomach acid produced. Both may be effective in relieving symptoms. Prescription drugs may be more effective in healing irritation of the esophagus and relieving symptoms. This therapy needs to be discussed with your surgeon.
Patients who do not respond well to lifestyle changes or medications or those who continually require medications to control their symptoms, will have to live with their condition or may undergo a surgical procedure. Surgery is very effective in treating GERD.
WHAT ARE THE ADVANTAGES OF THE LAPAROSCOPIC METHOD?
The advantage of the laparoscopic approach is that it usually provides:
•reduced postoperative pain
•shorter hospital stay
•a faster return to work
•improved cosmetic result
•Laparoscopic anti-reflux surgery (commonly referred to as Laparoscopic Nissen Fundoplication) involves reinforcing the "valve" between the esophagus and the stomach by wrapping the upper portion of the stomach around the lowest portion of the esophagus - much the way a bun wraps around a hot dog.
•In a laparoscopic procedure, surgeons use small incisions (1/4 to 1/2 inch) to enter the abdomen through cannulas (narrow tube-like instruments). The laparoscope, which is connected to a tiny video camera, is inserted through the small incision, giving the surgeon a magnified view of the patient's internal organs on a television screen.
•The entire operation is performed "inside" after the abdomen is expanded by inflating gas into it.
WHAT TO EXPECT BEFORE LAPAROSCOPIC ANTI-REFLUX SURGERY:
•Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
•It is recommended that you shower the night before or morning of the operation.
•After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
•Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
•Quit smoking and arrange for any help you may need at home.
WHAT TO EXPECT THE DAY OF SURGERY:
•You usually arrive for surgery the morning of the operation.
•A qualified medical staff member will place a small needle/catheter in your vein to dispense medication during surgery.
•Often pre-operative medications are necessary.
•You will be under general anesthesia - asleep - during the operation.
•Following the operation you will be sent to the recovery room until you are fully awake.
•Patients may stay in the hospital the night of surgery or may be discharged as soon as the same day of surgery.
WHAT SHOULD I EXPECT AFTER SURGERY?
•Patients are encouraged to engage in light activity while at home after surgery.
•Post operative pain is generally mild although some patients may require prescription pain medication.
•Anti-reflux medication is usually not required after surgery.
•Some surgeons modify patients diet after surgery beginning with liquids followed by gradual advance to solid foods. You should ask your surgeon about dietary restrictions immediately after the operation.
•You will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse.
•Call and schedule a follow-up appointment within 2 weeks after your operation.
ARE THERE SIDE EFFECTS TO THIS OPERATION?
Studies have shown that the vast majority of patients who undergo the procedure are either symptom-free or have significant improvement in their GERD symptoms.
Long-term side effects to this procedure are generally uncommon.
•Some patients develop temporary difficulty swallowing immediately after the operation. This usually resolves within one to three months after surgery.
•Occasionally, patients may require a procedure to stretch the esophagus (endoscopic dilation) or rarely re-operation.
•The ability to belch and or vomit may be limited following this procedure. Some patients report stomach bloating.
•Rarely, some patients report no improvement in their symptoms.
This guide is intended to provide a general overview of GERD and laparoscopic anti-reflux surgery. It is not intended to serve as a substitute for professional medical care or a discussion between you and your surgeon about the need for a laparoscopic anti-reflux surgery.
In addition to weight loss surgery we perform minimally invasive general surgery procedures for diseases involving the stomach, gallbladder, colon as well as surgery for reflux, hernias and other gastrointestinal diseases.
If you need surgery for any of these conditions please call to schedule a consultation.