What is Gastroesophageal Reflux?
Gastroesophageal reflux, acid reflux or heartburn occurs when secretions
from the stomach back up or reflux into the esophagus (the tube that connects the mouth
to the stomach). The secretions typically have a high concentration of acid and act by irritating
and inflaming the esophagus. Typically it causes a harsh, burning sensation in the chest
or upper abdomen, and can radiate throughout the chest or up to the throat. It may lead
to other symptoms such as difficulty swallowing, chronic coughing, sour taste, bad breath,
vomiting, wheezing and erosion of tooth enamel. Over time, these secretions can cause permanent
damage to the esophagus and lead to narrowing or stricture of the esophagus, ulcerations,
metaplastic changes (Barrett’s esophagus), and even esophageal cancer.
How is Gastroesophageal Reflux treated?
There are progressive steps in the treatment
of Gastroesophageal reflux
- Gastroesophageal reflux may be reduced by making changes in habits
or diet. Weight loss, smoking cessation, reducing alcohol consumption, lowering anxiety
or stress, dietary modifications and changing sleep habits can help decrease the symptoms.
- Medications such as antacids can help neutralize stomach acid or block
the secretion of stomach acid. These can be obtained from your doctor.
- The Nissen fundoplication anti-reflux surgery procedure is an option
that alleviates chronic heartburn where the patients condition cannot be controlled by
medication or other means.
What is the Nissen Fundoplication Procedure?
Nissen fundoplication is a procedure for strengthening the valve muscle
between the stomach and the esophagus preventing stomach acids from being forced back up
into the esophagus.
Normally, a circular band of muscle called the lower esophageal sphincter acts like a one-way
valve and only opens when swallowing. The lower esophageal sphincter should otherwise remain
closed and prevent the back up of any stomach secretions into the esophagus. If the lower
esophageal sphincter becomes weakened or abnormally relaxes, the stomach secretions can
reflux up and cause the associated symptoms. These changes in the lower esophageal sphincter
can also be exacerbated by the presence of a hiatal hernia. This occurs when a portion of
the stomach protrudes through the diaphragm and goes up into the chest.
The Nissen fundoplication proceedure offers a good chance of correcting this condition.
A recent study found that 90 percent of patients undergoing the procedure are symptom-free
after 10 years.
Advantages of the Laparoscopic Nissen Procedure
First performed by Dr. Rudolph Nissen in 1951, Nissen fundoplication is
performed laparoscopically with three small incisions, patients experience minimal pain
and fast recovery, patients can return to work within two weeks.
To prevent stomach acids from being forced back into the esophagus, The surgeon must strengthen
the "valve" between the stomach and the esophagus. This is achieved by folding
a part of the upper portion of the stomach, or fundus, around the bottom of the esophagus
strengthening the Stomach Valve.
Patients often have hiatal hernias, contributing to the condition causing
a burning sensation that in the chest and throat. Although this condition alone cannot cause
gastroesophageal reflux, The surgeon repairs the hernia.
In a small percentage of cases-about one in 50 (about 2 %) the surgeon is unable to complete
the Nissen fundoplication laparoscopically, and must revert to an open procedure.
Not all patients with heartburn need or can benefit from Nissen fundoplication.
The surgeon will carefully evaluate your condition and discuss the benefits, risks, and
possible complications of the operation.
The Typical Program
- Day 1 - Arrival and MRSA Test
- Day 2 - Consultation and clinical checks
- Day 3 - Surgery
- Day 4 - Stay in hospital
- Day 5 - Post operative check and departure
Because laparoscopic Nissen fundoplication is performed under general anesthesia,
you cannot eat or drink anything after midnight the day before the surgery.
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Recovering after the procedure
In the hours following the operation, you will experience some pain from
the small incisions your surgeon made to perform the procedure. After three or four days,
you can expect to return home, where you will be able to take care of yourself.
Within a week or so of leaving the hospital, you can resume your normal schedule, including
returning to work. After a few weeks you can also resume fitness programs and sports competition.
The surgical incisions will be barely visible a few months after the procedure.