What is Gastro-Oesophageal Reflux Disease?
When a person suffers continual acid reflux this can cause a series of symptoms, for example continual heartburn, pain and dysphagia (medical term for difficulty swallowing), and in addition can ultimately cause scarring in the wall of the oesophagus (the 'gullet' connecting the throat to the stomach).
This is referred to as Gastro-Oesophageal Reflux Disease, sometimes known by the acronym 'GORD'.
There are a number of treatment options which are recommended before contemplating surgery - these include eliminating or cutting down some foods in the diet and using medication to reduce the acidity of the stomach contents.
Where these approaches have not reduced or eliminated symptoms, or where a permanent solution is the preferred option, surgery may be recommended.
What causes Gastro-Oesophageal Reflux Disease?
There is a valve (or 'sphincter') that sits at the junction of the stomach and the oesophagus that stops the acidic contents of the stomach washing up into the oesophagus.
Dysfunction of this valve causes acid reflux and GORD. It is common in cases where a hiatus hernia has developed, which is where a part of the top section of the stomach has squeezed upwards through the diaphragm and lodged there.
How should I prepare for the procedure?
Medication / supplements
You need to make the surgical team aware of any medication (including alternative / complementary medicines) or diet supplements you are taking before the procedure.
If you are a smoker, you must give up smoking 14-21 days before the procedure.
You do not need to make any changes to your diet ahead of surgery.
There are no specific hygiene requirements before surgery, however you should have a shower or take a bath either the night before or on the morning of the surgery.
What is involved in the procedure?
The objective of surgery is to stop reflux of stomach contents into the oesophagus. This is a two-step process:
- If a hiatus hernia is present, this is repaired.
- Modelling a replacement valve (this procedure is known as a 'Nissen fundoplication'). This is done by taking the topmost section of the stomach and effectively 'wrapping' it around the lower section of the oesophagus and fixing it using stitches.
The procedure is conducted under general anaesthesia and takes between one and two hours to complete.
The preferred approach is using , where a number of small incisions are made to the abdomen and laparoscopic instruments are inserted via these 'ports' to complete the operation.
Around one in ten laparoscopic procedures may need to be converted to open surgery. If this is the case, the small incisions are closed and another, larger incision is made to the upper abdomen, to enable Dr Silverman to directly visualise and conduct the procedure.
A hospital stay of a day or two is standard after this procedure.
Returning to normal activities
The following recovery timeline is recommended after this procedure:
Day 1 After Surgery
Days 2-14 After Surgery
Soft food diet only. Acid reduction medication should no longer be needed, but you will receive medication to stop you from vomiting. When eating during this period you should:
- Eat more slowly than normal and ensure all food is well chewed before swallowing.
- Not drink any fizzy / carbonated drinks.
After day 14 you can gradually adopt your normal diet.
Note: During this period, it is normal to not be able to eat a larger meal, to have some discomfort in the stomach. Diarrhoea is also normal during this period.
Day 21 After Surgery
Most patients can return to work at this point. Up until day 21 you should only do light exercise, such as walking, which will help your recovery. If the work you do is heavier manual work, or you are involved in sports or strenuous physical activities (eg weight lifting, high intensity gym training) you should delay these activities a little longer. Dr Silverman will be able to advise a suitable timeline.
When to contact Dr Silverman
You should contact Dr Silverman if you experience any of the following symptoms post surgery:
- Feeling faint or dizzy.
- Increasing pain.
- Severe pain when moving around / breathing / coughing.
- Fever / elevated temperature.
- Absence of bowel movement.
- Swelling of the abdomen.
- Trouble urinating.
- Lack of appetite (particularly if this persists beyond the 48-hour mark after the procedure).
Risks / complications
There are risks associated with all surgical procedures, such as wound infection, and risks relating to anaesthesia and bleeding during the procedure.
The risks / complications specific to surgery for GORD include:
- Injury to stomach, oesophagus and / or blood vessels.
- Difficulty swallowing (dysphagia).
- Weakening / loosening of reconstructed valve (this may occur months or years after the original surgery).
Dr Silverman will be able to discuss any possible risks or complications with you well ahead of the procedure.