General Surgery

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Why the Procedure is Performed ?

Your doctor may suggest surgery when:

  • You have symptoms of heartburn that get better when you use medicines, but you do not want to continue taking these medicines. Symptoms of heartburn are burning in the stomach that you may also feel in your throat or chest, burping or gas bubbles, or have trouble swallowing food or fluids.
  • Part of your stomach is getting stuck in your chest or is twisting around itself. This is called a para-esophageal hernia.
  • You have reflux disease and another related, serious problem. Some of these problems are strictures (a narrowing of your esophagus), ulcers in your esophagus, and bleeding in your esophagus.
  • You have reflux disease and aspiration pneumonia (a lung infection caused by inhaling contents of the stomach into the lungs), a chronic cough, or hoarseness.

What Are The Symptoms Of GERD ?

The main symptoms of GERD can be divided into typical and atypical symptoms :

Typical symptoms include a burning sensation in the chest, and regurgitation of food. These symptoms are general, and not necessarily specific for reflux disease. For instance, patients may experience chest pain or burning as a result of a primary cardiac problem, or they may be a manifestation of another primary esophageal disorder. It is imperative that the cause of the symptoms be clearly delineated by your physician so the proper therapy may be instituted. Regurgitation is also a relatively common complaint.

Atypical symptoms of GERD include:

  • Asthma
  • Chronic sinusitis
  • Chronic hoarseness
  • Difficulty swallowing (dysphagia)
  • Vomiting
  • Choking sensation at night time
  • Pneumonias
  • Excessive salivation.

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Fundoplication Surgery

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In most cases, the operation performed to correct gastroesophageal reflux is a procedure called fundoplication. The upper portion of the stomach (the fundus) is wrapped (plicated) around the lower portion of the esophagus and anchored securely below the diaphragm.

As a result:

  • The physical barrier that allows passage of material in or out of the stomach is strengthened.
  • A flap valve is created at the entrance of the stomach.
  • The wrap "inflates" as the stomach fills; a full stomach has a tighter valve than an empty one.
  • All the factors that normally create valve pressure (esophageal muscle, the diaphragm and abdominal pressure) are superimposed on each other for maximum effect.

The operation is effective long term in stopping esophageal reflux and relieving symptoms.

More than 90 percent of patients who have fundoplication surgery are able to leave hospital the next day, eating a soft diet. Most people are able to return to their normal activities, work or school within one to two weeks after surgery. The satisfaction rate with this procedure is 96 percent at one year.

Fundoplication has undergone several improvements. Using a laparoscope and several very small incisions, the surgeon can operate without making a large incision to open the abdomen. The operation is the same, but the patient is spared the long hospital stay and prolonged recovery time of open surgery. There is also less pain after surgery, less chance of wound infection and smaller scars because of the smaller incisions.

Five small abdominal incisions are used for laparoscopic fundoplication. Each incision is .5 to 1 centimeter (less than 1/2 inch) long.

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Risks For Any Anesthesia Are:

  • Reactions to medicines
  • Breathing problems, including pneumonia
  • Heart problems

Risks For Any Surgery Are:

  • Bleeding
  • Infection

Risks for this surgery are:

  • Gas bloat, which makes it hard to burp or throw up. It also causes bloating after meals. These symptoms slowly get better for most people.
  • Pain and difficulty when you swallow, for some people. This is called dysphagia. For most people, this goes away in the first 3 months after surgery.
  • Damage to the stomach, esophagus, liver, or small intestine. This is very rare.
  • Respiratory complications, such as a collapsed lung. This is also rare.
  • Recurrence of the hiatal hernia

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After the Procedure

Patients who have laparoscopic surgery usually spend 1 to 3 days in hospital. Those who have open surgery may spend 2 to 6 days in the hospital after the procedure.

Most patients go back to work 2 to 3 weeks after laparoscopic surgery and 4 to 6 weeks after open surgery.

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