Anti-Reflux Surgery
Reflux is defined as the splash of stomach contents into the esophagus.Reflux can be seen physiologically, that is, at the expected level, during the day. However, reflux disease is suspected when this splash is more frequent than expected and affects the quality of life of the person. If the person has reflux complaints more than twice a week, s/he should be evaluated by endoscopy for a pathological condition. If the esophagus is damaged, it is diagnosed as reflux esophagitis, and if the endoscopy does not show damage, nonerosive reflux disease is diagnosed.
What are the reflux symptoms?
The most common symptoms are heartburn, stomach acidity, and a sour-tasting mouth. Other than these, complaints such as burning chest, hoarseness and a sensation of food sticking may also be a sign of reflux. Reflux disease should be considered while examining recurrent upper respiratory tract infections, problems in oral and dental health, and pneumonia.
How is reflux diagnosed?
The first examination for the diagnosis of reflux is endoscopic evaluation. Whether there is laxity or hernia is evaluated in the gastric valve with endoscopy. Furthermore, the damage that reflux may cause in the esophagus is evaluated. If there is no finding on endoscopy but the patient has reflux complaints, 24-hour pH measurement may be required with the help of a device to be inserted at the lower end of the esophagus. Also, esophageal monometry, which evaluates the esophageal propulsive force, can be performed as an advanced examination.
What are the treatments of Reflux?
Reflux is a chronic disease. The aim of treatment is to increase the quality of life of the person and to prevent serious health problems caused by uncontrolled reflux. The first things to do are diet and lifestyle changes. Medical treatment is recommended for patients whose complaints do not improve despite these changes. Today, there are quite strong acid-reducing drugs used in the treatment of reflux. Patients can be treated for a long time without complaints with these drugs. However, in some cases, surgical treatment may be needed. Other than the surgical method, there are also endoscopic treatment methods. However, the success of these methods is lower than surgical treatments.
Which patients can have anti-reflux surgery?
Despite the success of medical treatment today, surgical treatment alternatives should be evaluated in some patient groups. Conditions in which surgical treatment options should be considered are as following;
Failed medical treatment (8-12 weeks of drug therapy, and cases where a series of dietary and social life recommendations could not achieve results),
Patients with advanced esophagitis and large gastric hernia seen in endoscopy
Young patients who do not want to use medication for life
Patients whose complaints continue after medical treatment
Patients whose complaints of chronic cough, hoarseness, asthma and chronic sore throat that do not recover despite treatments
Changes as cellular change in the esophagus (Barrett’s Esophagus)
The most effective method in the treatment of reflux is surgical treatment. Laparoscopic surgery is most commonly preferred. The generally preferred method is laparoscopic fundoplication.
How is laparoscopic anti-reflux surgery (Laparoscopic Fundoplication) performed?
In this method, the abdomen is checked with laparoscopy. The junction of the stomach and the esophagus is surgically examined and if there is a finding of gastric hernia, which we call hiatal hernia, this part is first repaired with sutures. If there is a extremely large gastric hernia, it may be necessary to put a patch on this area. Then, the upper part of the stomach, which we call the fundus, is released and rotated 270 or 360 degrees around the esophagus. The bandaged part formed acts as a valve between the stomach and the esophagus and creates a new barrier for reflux.
How is the process after anti-reflux surgery?
After the surgery, which is performed by creating small incisions with the laparoscopic method, no intense pain is felt for the first 2-4 hours. As of the next day of the surgery, the patient consumes soft foods. It is recommended to avoid solid foods for the first 2-3 weeks the sutures to heal in the repair area. Gas bloating due to the newly created valve system may be seen in the first 3-6 months, although not in every patient. It is recommended to avoid heavy lifting and intense constipation that may increase intra-abdominal pressure in the long term.
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