Laparoscopic Anti-Reflux (GERD) Surgery

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Definition

What is Laparoscopic antireflux surgery?

Gastroesophageal reflux disease (GERD) is a digestive disorder that affects the lower esophageal sphincter (the muscular ring connecting the esophagus with the stomach). Laparoscopic antireflux surgery (also called Nissen fundoplication) is used in the treatment of GERD when medicines are not successful.

When is Laparoscopic antireflux surgery needed?

People with severe, chronic esophageal reflux might need surgery to correct the problem if their symptoms are not relieved through other medical treatments. If left untreated, chronic gastroesophageal reflux can cause complications such as esophagitis, esophageal ulcers, bleeding, or scarring of the esophagus.

Laparoscopic antireflux surgery (also called Nissen fundoplication) is used in the treatment of GERD when medicines are not successful. Laparoscopic antireflux surgery is a minimally-invasive procedure that corrects gastroesophageal reflux by creating an effective valve mechanism at the bottom of the esophagus.

Precautions

What should you know before undergoing Laparoscopic antireflux surgery?

Not everyone can safely undergo this procedure. Laparoscopic antireflux surgery is most appropriate for people who have not had previous abdominal surgery, those who have small hiatal hernias without complications of GERD, and those who experience most symptoms of reflux when lying down.

What are the complications and side effects?

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. Reflux symptoms can also return months to years after the procedure.

Although the operation is considered safe, complications may occur as they may occur with any operation.

Complications may include but are not limited to:

  • Adverse reaction to general anesthesia
  • Bleeding
  • Injury to the esophagus, spleen, liver, stomach or internal organs
  • Infection of the wound, abdomen, or blood.

Other less common complications may also occur.

It is important you understand the precautions and know the possible complication and side effects before having this Laparoscopic antireflux surgery. If you have any questions, please consult with your doctor or surgeon for more information.

Process

How do I prepare for Laparoscopic antireflux surgery?

You may need the following tests:

  • Blood tests (complete blood count, electrolytes, or liver tests).
  • Esophageal manometry (to measure pressures in the esophagus) or pH monitoring (to see how much stomach acid is coming back into your esophagus).
  • Upper endoscopy. Almost all people who have this anti-reflux surgery have already had this test. If you have not had this test, you will need to do it.
  • X-rays of the esophagus.

Always tell your provider if:

  • You could be pregnant.
  • You are taking any drugs, or supplements or herbs you bought without a prescription.

Before your surgery:

  • You may need to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other drugs or supplements that affect blood clotting several days before surgery. Ask your surgeon what you should do.
  • Ask your provider which drugs you should still take on the day of your surgery.

On the day of your surgery:

  • Follow your provider’s instructions about when to stop eating and drinking.
  • Take the drugs your doctor told you to take with a small sip of water.
  • Follow instructions for showering before surgery.
  • Your provider will tell you when to arrive at the hospital. Be sure to arrive on time.

What happens during Laparoscopic antireflux surgery?

The procedure may take a few hours, depending on the severity of your condition. Expect to stay in the hospital 1 to 3 days after surgery.

An anesthesiologist will inject medication into your IV that will put you to sleep.

After you are asleep, the nurses will cleanse your abdomen with antibacterial soap and cover you with sterile drapes.

The surgeon will make a small incision in your abdomen, through which a small sterile tube is passed. Through the tubing, carbon dioxide is passed into the abdominal cavity to lift the abdominal wall away from the organs below. This space provides your surgeon a better view and more operating space.

The laparoscope, which is connected to a video camera, is placed through the small incision, made above your belly button. The images your surgeon sees in the laparoscope are projected onto video monitors placed near the operating table.

Before starting the surgery, your surgeon will inspect your abdominal cavity to make sure that laparoscopy will be safe for you. Some reasons why laparoscopy might not be done include multiple adhesions (scar tissue), infection, or any unsuspected or widespread abdominal disease.

If your surgeon decides that laparoscopic surgery can be safely performed, four to five additional small incisions will be made. Instruments called trocars and cannulas are inserted through the small incisions. These incisions will give your surgeon access to the abdominal cavity in order to perform the surgery.

To correct GERD, the surgeon reduces the hernia (returns the stomach into the abdomen), and wraps the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This reinforces the lower esophageal sphincter so that food will not reflux back into the esophagus.

Finally, your surgeon will check that there are no areas of bleeding, rinse out the abdominal cavity, and close the small incisions.

What happens after Laparoscopic antireflux surgery?

When you wake up from surgery, you will be in a recovery room. You will have an oxygen mask covering your nose and mouth. This mask delivers a cool mist of oxygen, which helps eliminate the remaining anesthesia from your system and soothes your throat. Your throat might be sore from the breathing tube that was present during your surgery. This soreness usually subsides after one or two days.

Once you are more alert, the nurse in the recovery room will switch your oxygen delivery device to a nasal cannula, a small plastic tube that hooks over your ears and lies beneath your nose. Your nurse will frequently check your blood oxygen level. Depending on the percentage of oxygen measured in your blood, you might need to keep the oxygen in place after you are transferred to your hospital room.

Once you have recovered from anesthesia, you will be transferred to your hospital room. After your surgery, the nurses will measure your “intake and output.” They will document all the fluids that enter your body, and measure and collect any urine or fluids you produce, including those from tubes or drains placed during surgery.

A follow-up appointment will be scheduled two days after surgery if you live far away. You will be asked to stay in a hotel/motel the day before the appointment. If you live in the area, your follow-up appointment will be about one week after your surgery. You will have a chest X-ray, and your surgeon or nurse practitioner will assess the wound site and your recovery. The surgeon or nurse practitioner will provide guidelines about your activity and diet at this time.

If you have any questions or concerns, please consult with your doctor or surgeon for more information.

Recovery

What should you do after Laparoscopic antireflux surgery?

Patients are encouraged to engage in light activity while at home after surgery, and should avoid heavy lifting or strenuous activity for a short period of time which will be determined by your surgeon.

Most surgeons temporarily modify patient’s 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.

Stick to your follow-up appointments with your doctor.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: September 12, 2018 | Last Modified: September 12, 2018

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