Gastro-oesophageal reflux or simply ‘reflux’ is a condition where stomach acid flows into or ‘refluxes into’ the oesophagus. It is normal for the stomach to produce acid in order to help digest food, but the acid should be kept in the stomach by a valve mechanism called the lower oesophageal sphincter. This valve (sphincter) is at the join between the stomach and oesophagus. A weakness of this valve mechanism is what allows acid to flow up into the oesophagus. The oesophagus is not designed to deal with large amounts of acid, and it is the effect of the acid on your oesophagus which can cause you problems. You may get typical symptoms of reflux such as burning or an acid taste in your mouth, some people have trouble with less common symptoms like a cough, worsening of asthma or a change in your voice. The stomach acid can also damage your oesophagus called ‘oesophagitis’ and in some people lead to precancerous changes in the oesophagus called ‘Barrett’s oesophagus’.
Reflux can be effectively treated by an operation called laparoscopic fundoplication. This is a key hole operation to use part of the stomach (known as the fundus) to tighten the lower oesophageal sphincter (valve between stomach and oesophagus) This has the effect of preventing stomach acid from flowing into your oesophagus. Laparoscopic fundoplication is a very effective operation in fixing reflux disease, and over 90% of people who have it are very pleased with the result. It is performed safely as a day procedure or with an overnight stay.
Side effects to be aware of
All operations have side effects or potential complications you need to be aware of. Risks of any operation include the risk of the anaesthetic, small risks of bleeding, infection and hernias developing in the key hole entry sites. Specific to fundoplication you need to know your surgeon is operating in the area of major blood vessels called the aorta and the vena cava, nerves which help the stomach to empty, the oesophagus, stomach, liver and spleen. Although injuries to these are rare, they can occur.
After tightening the sphincter with a fundoplication, some people can have difficulty swallowing. This is usually temporary and gets better as the swelling from the operation goes down. Occasionally further treatment may be necessary. Tightening the sphincter can also affect how the stomach processes wind. About 20-30% of people find that they get wind symptoms after fundoplication. This can be ‘gas-bloat’ syndrome where you feel bloated, have difficulty with belching or vomiting, or get increased flatulence. Longer term sometimes the fundoplication can ‘slip’ or come undone, rarely it can slip into the chest and cause troubles with swallowing.
Non operative treatment
You have the option of continuing with your medication and making lifestyle modifications to try and manage your reflux.
What To Expect
You will be admitted to the hospital on the day of your operation. You will meet the nursing staff and the anaesthetist who will be administering your anaesthetic. After your operation you will wake up in the recovery area of the hospital where specialized recovery nurses will look after you and ensure you recover from your anaesthetic safely. After this you will be moved either to the day stay area of the hospital or to the ward. At any stage if the nurses have concerns about your recovery they will contact your anaesthetist or Dr Hamer. After waking up from your operation you will initially be allowed water to drink. After this you will be allowed to try some food of a pureed consistency.
Side effects to be aware of
All operations have side effects or potential complications you need to be aware of. Risks of any operation include the risk of the anaesthetic, small risks of bleeding, infection and hernias developing in the key hole entry sites. Specific to laparoscopic cardiomyotomy you need to know that your surgeon is operating in the area of major blood vessels called the aorta and the vena cava, nerves which help the stomach to empty, the oesophagus, stomach, liver and spleen. Although injuries to these are rare, they can occur.
After your operation
Dr Hamer may prescribe a diet before surgery known as a VLCD. This is a diet designed to take fatty deposits out of your liver, making your surgery safer. This is usually prescribed for 2 weeks before surgery.
You will need to be careful with what you eat after your fundoplication. For the first month you should eat only very soft foods that don’t require a lot of chewing. A rough rule of thumb is that everything should be the consistency of food that has gone through a blender. You should avoid bread, red meat and chicken. You should avoid fizzy drinks during this period. After a month you can slowly start trialing a normal healthy diet again. If you are having trouble with any particular food simply stop and try again in a week or two.
The aim of your operation is to come off your anti-reflux medications. After your operation you should continue taking them for 3-4 weeks, then slowly wean yourself off them. If you come off too quickly you may find that some of your symptoms temporarily recur. If this happens, start taking them again, but try coming off them slowly again in a couple of weeks.
After your operation, even if you have been discharged on the same day, the effects of the anaesthetic can take 24 hours to wear off. You need to avoid driving, operating machinery, drinking alcohol, climbing ladders, make any important or legal decisions. You should have a responsible adult with you for this 24hr period.
After you have been discharged from the hospital, you will have dressings over your wounds. Dressings do not affect how well your wounds heal, but they do protect your clothes from any seepage which may occur. If they become dirty or wet, they may simply be removed and changed for a similar dressing or a band aid. After a week they can be removed and discarded. Occasionally people feel more comfortable leaving a dressing on for an extra week, particularly if the wound is somewhere that rubs on clothing.
Your wounds will be closed with either glue or dissolving sutures, neither of these need removal.
Most people find taking regular paracetamol to be enough for their pain. Paracetamol has the advantage (unlike most other pain killers) that it won’t make you constipated or feel woozy. It is also very safe if taken carefully according to the instructions on the packet. In some circumstances you will be given additional pain killers to take home with you. If this is the case, you should read and follow the instructions carefully.
Complications are unusual. If you do have any problems you have multiple ways of accessing help. During office hours you can contact Dr Hamer’s rooms or your GP. For more pressing problems or after hours you can also contact the emergency department at the hospital.
Generally most people find that they are fit to return to light duties at work after 1 -2 weeks. You should avoid heavy lifting for four weeks after your operation. If you are still having significant problems at this time you should be reviewed to ensure you are still recovering properly.
You will be reviewed 4-6 weeks after your operation to ensure you have recovered.