Laparoscopic antireflux surgery is used to treat a medical condition known as GERD, also known as gastroesophageal reflux disease which causes moderate to severe heartburn in a person, due to backtracking of the stomach acid up the food pipe. This surgery is of two types namely fundoplication and laparoscopy.
Heartburn can be caused by a variety of digestive problems but it is mainly a symptom of GERD. In this disease, stomach acid moves back into the oesophagus and creates a burning sensation in the chest. This sensation can move from the chest to throat, some of GERD symptoms are vomiting, difficulty in swallowing and prolonged coughing.
After food intake, it moves from mouth to the stomach via a long cylindrical tube called oesophagus also known as food pipe. There is a small muscular opening in the oesophagus in the lower end, called lower esophageal sphincter. It is a one-way valve that allows the food to enter in the stomach and it closes immediately after entry of food to prevent the backflow of food and stomach contents into the oesophagus.
GERD is caused due to improper function of the lower esophageal sphincter. This improper functioning of LES leads to backflow of the stomach acid. The stomach acid causes irritation and burning in oesophagus, also damaging its inner lining. In some patients, changes occur in the cells of the oesophagus lining, this condition is called Barrett’s oesophagus which can lead to esophageal cancer.
GERD can be present in a person from birth or it can be caused due to unhealthy lifestyle – fatty and spicy foods, alcohol consumption, tight clothing and smoking are other causes of the relaxing in the lower esophageal sphincter. GERD patients also suffer from hiatal hernia. This is a condition in which the above part of the stomach bulges in the diaphragm and chest cavity.
Generally, medications are provided as the primary aid and often lifestyle changes are recommended. Eventually, surgery is performed if results are not satisfactory.
Before surgery, certain procedures like blood tests to check the health status, x-ray and other routine tests are performed. Written consent is asked by the doctor regarding age and operation. Meal consumption is prohibited at least 10-12 hours before the surgery – although, water is allowed.
Other medications should be avoided for at least one week before surgery. Unhealthy habits should be avoided as well. Anaesthesia is given to the patient before surgery.
Laparoscopic antireflux surgery is initiated by making an incision at a relevant angle for clear vision. Carbon dioxide is administered to dilate the area for the procedure. A narrow tube is used for the surgery. A camera is installed at the head of the tube for an appropriate view – following which the valve between the stomach and the oesophagus is reinforced.
This is done by coiling the upper part of the stomach and the lower part of the oesophagus together. Few days of stay might be recommended by the doctor based on the condition of the patient. After surgery, rest is required and exercise is prohibited. Operated area can be a little sore and mild pain is normal. A specific diet is assigned and a regular clinic visit for some time will be beneficial. The patient should consult the doctor if he experiences high fever, prolonged coughing, increasing pain and swelling in the abdomen, breathlessness, pus from the operated area, redness, dizziness, vomiting and increased swallowing problem.
Surgery is done using a special thin tube with a light on its end, which is inserted in the body for further process. The surgeon can make a large cut on the abdomen for open surgery or small cuts can be made for laparoscopic surgery – the esophageal sphincter is wrapped with the top part of the stomach and is sewed.
A ring of titanium is placed around the lower part of the oesophagus which strengthens the valve. In this procedure, the cut is often made in the chest or abdomen. The uppercut is useful for people with a short oesophagus. The patient is likely to stay for up to 3-4 days after surgery since the cut is small in surgery, pain is negligible. This surgery is done to cure GERD caused by hiatal hernia as medicines are less effective.
As compared to open surgery, fundoplication is preferred – the healing process and time is relatively less. During open surgery, general anaesthesia is given so that patients won’t experience any pain. Recovery from open surgery may take weeks.
Fundoplication shows best results for almost all the patients but occasionally there is a risk of the redevelopment of heartburn, it can cause discomfort due to buildup of gas in the abdomen, a minor infection can occur, bloating, the oesophagus may slip out of the spiral.
Hiatal hernia is the main reason for fundoplication. It is a medical condition in which the stomach pushes in the diaphragm and chest cavity. Hiatal hernia symptoms include burping, nausea, burning sensation and pain in the stomach. It is a chronic disease and can be lifelong if not cured on time. It is caused due to the bigger opening of the hiatus than usual, due to increased abdominal pressure caused by obesity, weightlifting, coughing and pregnancy. It is also called stomach hernia and urgent treatment is required.
The advantages of the laparoscopic surgery are reduction in pain, faster and improved results, easy return to the job after surgery and a shorter stay in the hospital.
Some disadvantages include problems in swallowing, endoscopic dilation may be required and indigestion or vomiting is experienced. Though these symptoms gradually disappear, you should consult your doctor if symptoms persist.
What is the cost of laparoscopic anti-reflux surgery?
The cost of the laparoscopic anti-reflux surgery generally ranges between $12,000 and $25,000 depending on the hospital fee – while Fundoplication costs around $4000.
What are the complications of laparoscopic anti-reflux surgery?
The complications include, reaction to anaesthesia, internal bleeding, infection of the blood, abdomen and wound, injury of other internal organs like stomach, spleen, liver and food pipe.
How to prepare for laparoscopic anti-reflux surgery?
Ask the doctor for the diet, stop all other medications one week before surgery, take a shower, avoid eating for at least 10 hours and the patient should be accompanied by someone for aftercare.
Is there any alternative to laparoscopic anti-reflux surgery?
Initially, mild drugs are given for improvement of symptoms. Then for effective and immediate results surgery can be done. Lifestyle affects health, it should be healthy and an appropriate diet is compulsory.
How long does the procedure take to finish?
The procedure usually takes one to one and a half-hour. But for recovery three to four hours rest is necessary for the patient. Some patients may need to stay the night and can be discharged after 3-4 days.