What is Gastroesophageal Reflux Disease (GERD)?
Although “heartburn” is often used to describe a variety of digestive problems, this term more accurately describes the main symptom of gastroesophageal reflux disease (GERD). In this condition stomach acids reflux, or “back up”, from the stomach into the esophagus. Patients usually characterize heartburn as a harsh, burning sensation behind the breastbone (sternum). This pain may radiate to the back of the chest or into the throat and neck. Many adults in the United States experience heartburn at least once a month. Other symptoms of reflux include vomiting, difficulty swallowing, chronic coughing, or wheezing.
What Causes GERD?
When you eat, food travels from your mouth to your stomach through a tube called the esophagus. A small ring of muscle, called the lower esophageal sphincter (LES), is located at the lower end of the esophagus. The LES acts like a one-way valve, allowing food to pass through to the stomach, then closing immediately afterwards to prevent reflux of acidic stomach juices into the esophagus. Reflux occurs when the LES malfunctions and allows acid to irritate the lower esophagus. This inflames the lining of the esophagus and may eventually lead to ulceration, scarring, and narrowing of the esophagus.
What Contributes to GERD?
Some people are born with a naturally weak sphincter (LES). For others, however, fatty and spicy foods, certain medications, tight clothing, smoking, drinking alcohol, vigorous exercise, or changes in body position (bending over or lying down) cause the LES to relax, producing reflux. A hiatal hernia (a term erroneously used interchangeably with reflux disease) may or may not be present in patients with reflux. There are a number of people with reflux who do not have a hiatal hernia, just as there are many people with a hiatal hernia who do not reflux.
How is GERD Treated?
Reflux is generally treated in three progressive steps:
1.Lifestyle Changes: In many cases, changing diet, losing weight, reducing smoking and alcohol consumption, and altering eating and sleeping patterns reduce the frequency and harshness of symptoms.
2.Drug Therapy: If symptoms persist after these lifestyle changes, drug therapy may be required. Antacids such as Maalox, Riopan, and Amphogel neutralize stomach acids. Over-the-counter medications (such as Pepcid AC and Tagamet AC) reduce the amount of acid produced by the stomach. Both may be effective in relieving symptoms, but if they do not work, stronger prescription drugs may be required. This therapy needs to be discussed with your surgeon.
3.Surgery: Patients who do not improve with lifestyle changes or drug therapy, or who continually require medications to control their symptoms, are candidates for surgery. Surgery is very effective in treating GERD. However, until recently this operation required a large abdominal incision resulting in significant pain and a recovery period of six weeks or more. Now we use a laparoscope to do the procedure, avoiding the necessity of a large abdominal incision.
How is Laparoscopic AntiReflux Surgery Performed?
• Laparoscopic antireflux 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 esophagusmuch the way a bun fits around a hot dog. • In a laparoscopic procedure, surgeons insert cannulas (narrow tubes) through small incisions (1/4 to 1/2 inch) to enter the abdomen. The laparoscope, which is connected to a tiny video camera, is inserted through the cannula, and gives the surgeon a clear, magnified view of the patient’s internal organs on a television screen. Instruments such as forceps and scissors are inserted through other incisions and the entire operation is performed “inside” without making a large incision.
What are the Risks of Laparoscopic AntiReflux Surgery?
Although the operation is considered safe, complications may occur, as they may occur with any operation. Complications during the operation may include: Adverse reaction to general anesthesia, bleeding, or injury to the esophagus, spleen, or the stomach. Complications after the operation may include: Infection of the wound, abdomen, or blood.
What happens if the Operation Cannot were Performed Laparoscopically?
In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. Factors that increase the possibility of converting to an “open” procedure include obesity, bleeding problems during the operation, or a history of prior abdominal surgery causing dense scar tissue. The decision to perform an open procedure is made by your surgeon either before or during the actual operation and is based strictly on patient safety. What are the Side Effects of this Operation? • Long-term side effects of this procedure are generally uncommon. • Some patients develop temporary difficulty swallowing immediately after the operation. This usually resolves within one to three months after surgery. Occasionally, these patients require a simple procedure to expand or dilate the esophagus (endoscopic dilation). Rarely they need another operation. • There may be a limited ability to belch or vomit following this procedure. Some patients complain of abdominal bloating. • Rarely, patients report no improvement in their symptoms.
What are the Expected Results after Laparoscopic AntiReflux Surgery?
Studies have shown that the vast majority of patients who undergo the procedure become symptom free or have significant improvement in their symptoms. The advantage of the laparoscopic approach is that it usually provides: 1. Reduced postoperative pain. 2. Shorter hospital stay. 3. A faster return to work. 4. Improved cosmetic result.