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What is gastroesophageal reflux disease (GERD)?
What causes GERD?
If I have GERD, does this mean I need to have surgery?
How is laparoscopic repair of GERD done?
How safe is laparoscopic anti-reflux surgery?
Is this procedure always done laparoscopically
now?
What will it be like after my surgery?
What is gastroesophageal reflux disease (GERD)?
Gastroesophageal reflux disease (GERD) is a relatively common problem caused
when gastric juices from the stomach containing acids and other digestive enzymes
flow back up into the esophagus. This causes a burning sensation, usually felt
in the center of the chest, although it may spread to the throat, the neck, and
across the chest. It is commonly called “heartburn”.
What causes GERD?
The lower 1-2 inches of the esophagus have a sphincter mechanism which prevents
gastric juices from getting into the esophagus. However, this sphincter acts like
a one-way valve, allowing food to pass through to the stomach. GERD occurs when
the sphincter does not function properly and allows stomach contents to flow back
into the esophagus. This irritates and inflames the esophagus, causing discomfort,
and if left untreated it can eventually damage the esophagus, causing bleeding,
blockage or pneumonia and inflamed vocal cords if the juices flow as high as the
throat.
Some people have only occasional discomfort. Some find that certain factors
will increase their symptoms. This may be fatty or spicy foods, certain medications,
tight clothing, smoking, drinking alcohol, exercise, and bending over or lying
down. GERD is often, but not always, associated with a hiatal hernia, which is
a weakness in the diaphragm in the area of the esophageal sphincter, which may
or may not increase symptoms. Many people have hiatus hernia, but only 20% of
these have GERD.
If I have GERD, does this mean I need to have
surgery?
Not always. As with most medical conditions (as opposed to cancers), the least
invasive treatment that is effective in controlling the condition is usually recommended.
Therefore, this will likely be tried before any surgery is suggested. These conservative
measures may consist of:
1) Life style changes:
Many people respond to simple measures, which may include:
· avoiding foods that cause symptoms (such as fat, chocolate, juices, alcohol,
etc.;
· losing weight (very important);
· stopping smoking;
· reducing alcohol consumption;
· sleeping with the head of the bed elevated;
· wearing loose garments; or
· taking over-the-counter antacids;
2) Medications:
If life style changes do not help, medications may. Over-the-counter antacids
act by reducing the acidity of the contents of the stomach. Prescription drugs
may be needed, which block the body’s production of gastric acid and reduce
the amount that is released into the stomach. If prescribed, it may be needed
for only a short time, or it may be prescribed to be taken indefinitely. If this
is the case, monitoring with certain tests may be necessary to be sure there are
no blood problems occurring, and x-rays or an endoscopy of the esophagus (EGD)
may be needed to be sure the esophagus does not show excessive inflammation or
a pre-cancerous condition called Barrett’s esophagus, or even cancer itself.
The advice of your doctor should be obtained and relied on if symptoms persist
or are not easily relieved by antacids or other conservative measures mentioned
above.
3) Surgical repair:
If significant symptoms continue, or complications such as bleeding or blockage
occur, or severe inflammation, then surgery may be needed. Techniques for surgical
repair of GERD have advanced in recent years, and it is now possible to avoid
a large abdominal incision and the usual 5 to 6 day hospital stay. Minimally invasive,
or minimal access, procedures, using a laparoscope, can now be performed, allowing
the patient to go home in 1 to 2 days, and back to work in a week or two.
How is laparoscopic repair of GERD done?
When a laparoscopic repair is done, the surgeon makes a small incision, and
with a camera he is able to see the organs so he can operate with long special
instruments. The abdomen is inflated with carbon dioxide gas so the organs can
be viewed.
The Nissen fundoplication is the best surgical correction for reflux. In this
procedure, the surgeon wraps the upper portion of the stomach around the lower
part of the esophagus, therefore increasing the pressure zone in the esophagus
and preventing the flow of acids up into the upper esophagus.
The advantages of a laparoscopic surgery rather than an open procedure are:
· Reduced pain after the surgery;
· Shorter stay in the hospital;
· Quicker return to normal activities; and
· Less scarring
How safe is laparoscopic anti-reflux surgery?
Any operation has risks, whether with a large incision or with laparoscopic
techniques, and your doctor should discuss these with you. Surgery is usually
recommended only after other measures have been tried, and usually when the surgeon
feels that the patient would be worse off if the surgery were not done.
Complications that could occur during the surgery include:
· Adverse reaction to anesthesia;
· Bleeding;
· Injury to the esophagus, spleen, or stomach; or
· Inability to perform the surgery laparoscopically.
Complications that may occur after the operation may include:
· Infection;
· Bleeding;
· Transient difficulty with swallowing or digestion;
· Pneumonia; or
· (Rarely) peritonitis.
This is why patients are followed very carefully during the hospital stay.
Is this procedure always done laparoscopically
now?
Not always. If certain conditions are present, such as previous abdominal surgery
that has left scarring and adhesions in the abdomen, if the patient is grossly
overweight, if there is a large hiatus hernia, or during the surgery the surgeon
cannot gain access to the required area, then the laparoscopic method is converted
to an open procedure.
In a small number of patients the laparoscopic method has to be converted to
an open procedure after the operation is started, usually because the organs cannot
be visualized or handled effectively. When the surgeon feels that it is safest
to convert the laparoscopic procedure to an open one, this is not a complication.
It is sound surgical judgment. The decision to perform the open procedure is a
judgment decision made by the surgeon, and is strictly based on patient safety.
The difference in the hospital stay is two to three days.
What will it be like after my surgery?
Post operative pain is usually mild, although some patients may require pain
medication.
Most patients will not require anti-reflux medications.
A liquid diet is usually started immediately after surgery and gradually advanced
to a normal diet as tolerated. Most patients will probably be more comfortable
eating smaller and more frequent meals than prior to surgery. This will change
with time.
Most patients are able to get back to normal activities within a short amount
of time, probably two to three weeks.
Some patients develop temporary difficulty swallowing immediately after the
operation. This usually resolves within one to three months after surgery. Occasionally,
these patients may require a simple procedure to expand the esophagus (endoscopic
dilation).
The ability to belch and or vomit may be limited following this procedure.
Some patients complain of stomach bloating.
If you would like more information about this procedure, or if you would like
to be evaluated for esophageal cancer, we will be happy to see you. Call us at
312-942-6500 to make an appointment.
If you do not live in the Chicago area, we suggest you ask your doctor for
a recommendation, call teaching hospitals in your area, or we may be able to help
you find someone in your state.
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