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Patient
information on surgery for Gastro-oesophageal Reflux Disease (GORD)
Introduction
The disorder from which you are suffering is known as gastro - oesophageal
reflux. In this disorder there is a weakening of the sphincter muscle
which normally keeps the stomach acid within the stomach. This muscle
weakness allows damaging gastric acid to flow back into your gullet
(oesophagus), causing the symptoms of heartburn and regurgitation
and inflammation of the oesophagus (oesophagitis).
Surgery
This condition can be alleviated by surgery (known as anti-reflux
surgery). During the operation the lower portion of the gullet is
freed from the diaphragm and then the edge of the stomach is freed
from the spleen. The stomach wall is then passed behind the gullet
and is stitched to itself so forming a collar of stomach around
the lower gullet (fundoplication) - rather like a tyre around a
wheel hub.
The
surgery can be performed by the key hole (laparoscopic) method or
by conventional open surgery. The advantages of the key hole approach
are the speed of recovery post -operatively and the ability to return
to work rapidly. Five or six incisions of 1.5cms length are made
on the abdominal wall; through these are placed the delicate camera
and the instruments used for the procedure which lasts approximate
1-2 hours. Stay in hospital is about 2-4 days.
Not
everyone is suitable for key hole surgery and some patients have
to be converted from the key hole to the open operation because
of technical difficulties. In these cases the patient will have
an abdominal incision: the post operative stay in hospital is approximately
6-8 days with a return to work of about 2-8 weeks.
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| The
oesophagus (gullet) and muscles of the diaphragm |
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Stitch
placed in muscles of
diaphragm |
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|
|
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| Stomach
wrapped around oeaophagus |
Side
effects of surgery
It is wise to remember that all surgery has side effects. Thi specific
ones relating to anti-reflux surgery are listed below.
| |
1. |
Difficulty
in swallowing solid food (eg meat & bread). |
| 2. |
Feeling full after small meals. |
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Both
these side effects are very common in the first six weeks after
surgery, but disappear in the majority of patients. In approximately
5% these side effects persist and may require further treatment.
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| 3. |
Flatulence. Most patients notice a mild increase in flatulence
for a short time post-operatively. |
| 4. |
Burping and vomiting. A few patients find restriction in the
ability to burp and vomit, but this is usually temporary. |
| 5. |
Recurrence of symptoms. All operations have their failures.
Figures indicate that 90% of patients will be free of reflux
symptoms 10 years after operation. |
| 6. |
Removal of the spleen. In very few patients (less than 1%) the
spleen may have to be removed because of injury at operation.
If so it may be necessary to take one penicillin tablet per
day following surgery. |
Advice
to follow after surgery
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1. |
Eating: Avoid bread, meat, roast and boiled potatoes
and wind producing foods such as baked beans, onion; cabbage
and turnip for 4 weeks. |
| 2. |
Drinking: Avoid fizzy/carbonated beverages for 4 weeks;
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| 3. |
Stitches: The stitches are usually dissolvable. |
| 4. |
Work / Exercise: Avoid heavy physical work and exercise
for 4 weeks. 80% of patients return to work after two weeks.
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| 5. |
Driving: You may be fit to drive after a week. Check
with your Insurance Company and make sure you can do an emergency
stop comfortably before you resume your driving. |
Post
operative Investigations
We are undertaking a rigorous evaluation of the results of anti-reflux
surgery. Your symptoms and well-being will be assessed independently
by Mr Dehn's G I Physiology nurses, 6 weeks, 6 months and 1 year
post operatively. It is important that we obtain independent and
scientific evidence of the results of this surgery. You will be
asked to have a repeat pH and manometry test 6 months post -operatively
and a repeat endoscopy one year post-operatively.
Outcome
of surgery >>
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