Anti-reflux surgery

What is it?

Reflux of acidic stomach content past the LOS.

Reflux disease is a common problem in our society. This can be mild with occasional heartburn after meals or more of a problem with daily symptoms of food coming into the oesophagus with meals, at night or at any time. This type of reflux may respond to medications such as PPI's eg somac, nexus and losec. Some patients are not completely controlled by these drugs and may be a candidate for an operation to fix the reflux

What causes Reflux?

Solving the reflux by wrapping the upper portion of the stomach around the lowest portion of the oesophagus.

Reflux is related to a number of factors. It is normal to reflux at times during and after meals. A belch or burp is a normal reflux episode. To prevent bloating. Other reflux episodes can be painful resulting in Heartburn and even regurgitation of food and liquids. This can even result in upper airway problems such as asthma and hoarse voice.

Reflux is caused by a combination of factors. There is a valve in the lower oesophagus which keeps stomach content in the stomach. This is called the lower esophageal sphincter or LES. Constant acid damage to the lining of the oesophagus around this valve weakens it and causes it to shorten. Another reason some people reflux is a hiatus hernia which is stretching of the diaphragm around the oesophagus. The diaphragm is an important muscle that holds the oesophagus tight and aids in preventing reflux.

The end result of chronic reflux is Barretts oesophagus. This is where the lower lining of the oesophagus changes from one cell to another. It may result in malignant change which is cancer of the oesophagus.

What is anti-reflux surgery?

This is an operation that is done through keyhole surgery and attempts to fix all of the problems I have discussed. The principles are reconstruction of the LES or fundoplication and repair of any hiatus hernia. It takes a lot of training and a large number of cases to become proficient at this operation. In my practice I have performed in excess of 100 antireflux operations and many more in my training. I perform a Nissan fundoplication or a partial toupet fundoplication depending on the individual.

What next?

If you experience reflux more than weekly or require medication you should have a screening endoscopy to expired Barretts change which needs to be watched very carefully.

If your reflux is not being controlled by medication or weight loss then you may be a candidate for surgery. If you suffer Barretts oesophagus there may be role for surgery to prevent progression to cancer. For more information see the esophageal cancer section and Barretts oesophagus section.

Prior to surgery you will need an endoscopy and a test to measure the function of the oesophagus called manometer and a test to measure your reflux called 24 hour ph testing. This is usually done at Frankston private day surgery with Judy Hooper an expert nurse.

For more information talk to your GP and if he/she feels it appropriate they will refer you for discussion.

Post-operation information

• Discharge home is usually day one post surgery.
• Your dressings are waterproof. Instructions regarding the care of these will be given before discharge.
• Patients are encouraged to engage in light activity once home.
• Post-operative pain is generally mild; a prescription for pain relief will be given to you before discharge.
• You are to be on a liquid diet for one week (seven days), post surgery. The liquid diet includes clear liquids & soft liquids.
• Week two, you will be able to commence a mushy diet.
• You may develop temporary swallowing difficulty immediately after this operation. This will usually resolve itself within one to three months.

More information

All of the information you need to know, pre and post-operatively, will be made available to you in separate information packs given to you before and after your surgery. Our practice nurse, Kylie, will also be able to assist you with any questions that you might have at any time.

Consent form

You are required to fill out a consent form prior to Anti-reflux surgery. You can obtain a form from our clinic or download the consent form and print it out yourself.