Anti-reflux surgery Information

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Scars from tissue damage can constrict the esophagus and make swallowing difficult. This brochure is intended to provide a general overview of GERD and laparoscopic anti-reflux surgery. It is not intended to serve as a substitute for professional medical care or a discussion between you and your surgeon about the need for a laparoscopic anti-reflux surgery. Specific recommendations might vary among health care professionals.

These clips help prevent food or stomach acid from backing up. Wrap the upper part of your stomach around the final end of your esophagus with stitches.

Learn the symptoms, causes, and treatments for Barrett’s esophagus. Over the last four years, the team at St George’s has successfully introduced Linx – a less invasive surgical operation involving the insertion of a magnetic barrier ring to improve acid reflux symptoms, before introducing the latest procedure Stretta. The procedure is now routinely performed laparoscopically. When used to alleviate gastroesophageal reflux symptoms in patients with delayed gastric emptying, it is frequently combined with modification of the pylorus via pyloromyotomy or pyloroplasty. “Most people with GERD are well managed with occasional medication and lifestyle changes fairly, such as stopping smoking and losing weight,” says Dr. Shah.

This first generation procedure was developed to assess the feasibility of the approach, and was designed-first and foremost-to demonstrate safety and efficacy. At the time, investigators were concerned with placing fasteners through the distal esophagus and elected instead to create gastro‐gastric plications distal to the gastroesophageal junction.

The advantage of the laparoscopic method is a speedier recovery and less post-operative pain. In about 10% of patients undergoing LARS, there will not be adequate intraabdominal esophageal length. Because the most common cause of failure after antireflux surgery is related to transdiaphragmatic herniation, at least 2.5 cm of tension-free intraabdominal esophagus must be present in order to perform a proper Nissen fundoplication. In most patients, maximal esophageal mobilization reaching up to the aortic arch will enable adequate length to be achieved. However, despite these efforts, some patients require an esophageal lengthening procedure such as a Collis gastroplasty.

A laparoscopic Nissen fundoplication in a morbidly obese patient is quite difficult. Some data suggests that the failure rate of a laparoscopic Nissen in morbidly obese patients is increased compared to the non-obese. Bariatric (weight-loss) surgery has been demonstrated to be effective in controlling and curing GERD in some patients. Morbidly obese persons who have GERD that is uncontrolled by medical therapy and who meet the criteria for antireflux surgery should talk to their doctor about the option of bariatric surgery.

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Your surgeon will always discuss these in more detail before your operation and give you an opportunity to ask questions. The RUH is proud of the innovations made in laparoscopic reflux repair surgery. In March 2012 the FDA approved the LINX System, comprised of a surgically implanted device to help manage reflux, for people with GERD who have not been helped by other treatments. After a fundoplication, some patients report difficulty belching or a sensation of abdominal bloating. This is rarely severe and generally resolves within the first 6 months after surgery.

The stomach contents also can come up the esophagus and enter the lungs. This is called “aspiration” (as-per-A-shun) and can cause cough, airway irritation or pneumonia even. The laparoscopic technique, in which the surgeon makes small incisions (cuts) in the skin and inserts tiny scopes or cameras to see inside the body while doing the repair.

The results achieved with the Nissen fundoplication should serve as the standard for surgical and endoscopic therapies directed at the treatment of GERD. To some, the results of this follow-up study were misconstrued to imply that surgical therapy for GERD is ineffective. It is important to remember that this was an intention to treat analysis, and several of the patients who were originally randomized to surgery, never received this therapy and remained on antisecretory therapy. A symptom-based questionnaire was delivered to subjects both on and off medical therapy; compared to the medically treated patients, those who underwent antireflux surgery had only a slight increase in GERD-related symptoms off medication. Furthermore, they had significantly lower symptom scores off medication than their medically treated counterparts.

Chronic or severe acid reflux is known as gastroesophageal reflux disease (GERD). Laparoscopic anti-reflux surgery (commonly referred to as Laparoscopic Nissen Fundoplication) involves reinforcing the “valve” between the esophagus and the stomach by wrapping the upper portion of the stomach around the lowest portion of the esophagus – much the way a bun wraps around a hot dog. 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. People with severe, chronic esophageal reflux might need surgery to correct the problem if their symptoms are not relieved through other medical treatments.

That’s why it’s so important to manage your symptoms long-term. Burning, nagging heartburn symptoms could be affecting you more than you think.

In most patients who do not tolerate medical therapy or in patients who have inadequate or incomplete relief of GERD symptoms from appropriate medical therapy, antireflux surgery – performed by experienced surgeons and in selected patients – is a safe and effective option appropriately. Gastroesophageal reflux disease (GERD) is defined as the back-flow of stomach contents into the esophagus causing undesirable symptoms and potentially resulting in esophageal damage. If a person has a hiatal hernia, which can cause gastroesophageal reflux disease (GERD) symptoms, it will be repaired during this surgery also.

Accessed December 19, 2012. Common complications reported during clinical trials include stomach bloating, dysphagia, pain, nausea, and vomiting.

Heartburn Foods SlidesLearn the symptoms of heartburn and which foods cause GERD or heartburn. Discover home remedies and which foods may provide treatment for heartburn relief. Tony, a builder from South Croydon, suffered with acid reflux symptoms for twenty years and took medication every day in an attempt to keep the symptoms at bay before being transferred to St George’s when Stretta became available. It affects approximately 20% of the population and although medication is usually successful in treating this condition, some patients with severe symptoms require surgery. Surgeons at St George’s carried out a new endoscopic treatment for acid reflux, called Stretta, in October for the first time.

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