Gastro-Oesophageal Reflux Disease (GORD)
The Surgical Treatment Option

Warning!

Please be advised that information on this page is not intended and MUST NOT be taken or used in any way as personal medical advice. Referral to LapSurgery Australia MUST come from your Family Doctor who is the only person qualified to advise you on the need for referral to a surgeon.

Contents

• Introduction

• Diagnosis

• Initial Management

• When to Consider Surgery

• Surgery

• Following Surgery

• Experience

• Success Rate

• Cost

• The Next Step

• Useful Internet Sites

/\  Introduction

Many people suffer reflux, heartburn or indigestion at some time in their life. This is caused by acidic contents in the stomach moving upwards and “burning” the delicate tissues of the gullet (oesophagus).
Normally there is a valve called the Lower Oesophagel Sphintcter or LOS that closes to stop food and liquids in the stomach from regurgitating back into the gullet. Reflux occurs when this valve does not work properly.
Weakening of the LOS, usually in association with a hiatus hernia, appears to be the main cause of Gastro-Oesophageal Reflux Disease (GORD). This problem affects 40 percent of otherwise healthy adults to varying degrees, with the incidence increasing over the age of 50.

/\  Diagnosis

The most common symptoms are:

• Heartburn produced by acid reflux into the gullet (oesophagus);

• Acidic tastes in the mouth which can often occur when bending over;

• Difficulties in swallowing and pain when swallowing;

• Chest pain;

• Burning in the throat;

• Hoarseness;

• Coughing;

• Regurgitation of food;

• Sleep problems;

• Adult onset asthma

• A common surgical procedure called a gastroscopy, when under sedation a qualified surgeon inserts a thin fibre-optic device down the throat and into the patient’s stomach to assess the condition. This is generally done as day surgery and is performed by each of the surgeons at LapSurgery Australia involved in the surgical management of reflux disease. This will determine whether there are any other problems.

• A 24 hour recording of the patient’s pH levels to determine if there is excessive acid reflux in the gullet (oesophagus);

• A procedure called Oesophageal Manometry that involves putting a small tube into the gullet (oesophagus) and measuring the function of the oesophagus and LOS. The purpose of this test is to exclude other diseases of the oesophagus that need different treatment options.

/\  Initial Management

Many patients find their symptoms can be controlled by simple changes to their lifestyle and diet. A range of medications are also available to minimise, and in some cases eliminate, gastric acid reflux and some patients find these are the answer. However for others, these treatment options are not successful and surgery is the only answer.

/\  When to Consider Surgery

Surgery offers a cure for GORD as the surgeon makes a new valve to replace the faulty LOS. The new valve cures reflux as it stops stomach contents from rushing up into the gullet (oesophagus). Surgery should be considered if:

• The medical management option fails to control symptoms;

• A patient elects not to take medication on a long term basis;

• A patient suffers continual regurgitation of food and acid contents into the back of the throat despite medication;

• If reflux symptoms cause respiratory complications such as coughing and asthma .

/\  Surgery

The main aim of the surgery is to create a new valve to replace the faulty Lower Oesophageal Sphincter (LOS) using a procedure called Nissen Fundoplication. This is done with keyhole surgery (laparoscopy) and involves making several small incisions in the stomach, then inserting a thin, telescope-like tube. A small video camera attached to the tube, or laparoscope, allows the surgeon to see the area clearly and manipulate the surgical instruments while watching a video monitor. Two of our experienced laparoscopic surgeons work together during the procedure to wrap the upper part of the stomach around the bottom of the gullet (oesophagus) to create a new valve to replace the faulty LOS. This is highly effective as it stops the reflux of the stomach contents into the gullet (oesophagus).
Laparoscopic surgery is preferred as generally patients:

• Suffer less discomfort;

• Make a quicker recovery;

• Spend less time hospital (usually just one or two days).

/\  Following Surgery

After the surgery and the affect of the general anaesthetic has worn off, patients can expect some discomfort in the upper abdomen, but this is easily controlled with mild painkillers.
All antacid medication is stopped and the patient is started on oral fluids the day after surgery. A special xray is performed to confirm that the gullet (oesophagus) is emptying satisfactorily.
As patients start to eat a light diet they may experience some difficulty in swallowing, especially solid or chunky foods. This gradually improves in the weeks following surgery.
Some patients may also experience gas bloating after the surgery. This is caused by reflex swallowing of air that is common in people suffering from GORD, but is generally overcome in time.
Patients can expect to remain in hospital for one-three days after the surgery, and return to work in one-two weeks.

/\  Experience

Our surgeons have successfully managed more than 150 patients using the Nissen Fundoplication procedure, and are extremely pleased with the results that they will happily discuss with you.
However, any surgical procedure carries some risk of complications, and these will be discussed by your surgeon.

/\  Success Rate

International studies shows that 90 percent of people who have reflux surgery have either a good or very good result, and our experience supports this.
A small percentage of people may still require some medication, and a very small percentage find that the operation is not effective.
While long-term results are generally excellent, a small percentage find that they may need repeat surgery at a later date.

/\  Cost of the Procedure

We will provide you with a full explanation of the cost of the operation before you decide to proceed.

/\  The Next Step

If you decide to take the next step you will need to ask your local doctor for a referral to see one of our surgeons. This referral will need to include information on your medical history, any past and current medication you are taking and any investigations you have had, in particular gastroscopies.
Once you have this referral simply contact LapSurgery Australia on (03)9795-9511 and make an appointment to see one of our experienced surgeons.

/\  Useful Internet Sites

Some useful Internet sites will be listed below to provide further information very soon...