Laparoscopic Antireflux Surgery

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Laparoscopic anti-reflux surgery is the standard surgical method in the treatment of gastro-oesophageal reflux disease, which occurs as a result of acid refluxing from the stomach back up into the oesophagus. This causes heartburn and inflammation. Ordinarily, there is an obstacle to acid reflux. Part of which is the lowermost muscle of the oesophagus (known […] Read More

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Laparoscopic Antireflux Surgery

Laparoscopic anti-reflux surgery is the standard surgical method in the treatment of gastro-oesophageal reflux disease, which occurs as a result of acid refluxing from the stomach back up into the oesophagus. This causes heartburn and inflammation. Ordinarily, there is an obstacle to acid reflux. Part of which is the lowermost muscle of the oesophagus (known as the lower oesophagal sphincter). Usually, this muscle is contracted and closes off the oesophagus from the stomach. However, in patients with reflux disease, the sphincter does not function as it should because the muscle either relaxes inappropriately or is weak and feeble. Laparoscopic anti-reflux surgical technique strengthens the barrier to acid reflux when the sphincter does not function normally. In laparoscopic surgical technique, about five or six small incisions are made in the abdomen. After which the abdominal cavity is inflated with carbon dioxide to lift the abdominal wall away from the organs below it and to provide an operating space in the abdomen. The laparoscope (a special camera) and other surgical instruments are inserted through the incisions. The laparoscope guides the surgeon through the transmission of images of the abdomen on a video monitor to ensure a seamless procedure can be performed. The laparoscopic technique of anti-reflux surgery generally involves less pain and scarring after surgery, have a quicker recovery, and possess less risk of infection than the traditional technique of anti-reflux surgery. 

Why is laparoscopic antireflux surgery required? 

Laparoscopic antireflux surgery is a minimally invasive antireflux surgery used in the treatment of GERD to correct gastro-oesophageal reflux by creating an effective valve mechanism at the bottom of the oesophagus.  Most people with reflux disease responds well to appropriate acid-suppressing drugs and may not need anti-reflux surgery. However, an antireflux surgery can be helpful to a small group of people, especially in circumstances such as: 
  • The desire to be free from long-term medication.
  • Unbearable side effects from medication.
  • Failed or unsatisfactory responses to adequate doses of medication.
Also, people with severe, chronic oesophageal reflux might need to undergo antireflux surgery to correct the problem if their symptoms are not relieved through other medical treatments. Because if left untreated, chronic gastro-oesophageal reflux can lead to complications such as oesophageal ulcers, esophagitis, bleeding, or scarring of the oesophagus.

Preparation for a laparoscopic antireflux surgery

Prior to laparoscopic antireflux surgery, a pre-surgical evaluation is first performed to be sure that laparoscopic antireflux surgery is the right treatment option for the patient. This evaluation generally lasts about two days and is usually scheduled a few weeks before the surgery date. Some of the activities carried out during the evaluation include
  • A complete physical examination.
  • Carrying out a number of tests to ensure you are physically ready for the surgery. Some of the tests are blood test, chest X-ray, electrocardiogram (ECG), lung function test, or other tests as ordered. The choice of tests, however, depends on age and general health.
  • Meeting with several healthcare providers, the surgeon inclusive, who will ask you several questions about your condition and your health history.
  • Meeting with an anesthesiologist (a specialist doctor in sedation and pain relief), who will discuss the type of pain relief medication you will be administered during the antireflux surgery, and the pain control you will be given after surgery.

Laparoscopic antireflux procedure.

An anesthesiologist will inject a sedative into your IV to put you to sleep. When you fall asleep, the nurses cleanse your abdomen with antibacterial soap and cover you with sterile drapes. The surgeon then takes over and start by making a small incision in your abdomen, through which a small sterile tube is passed into the abdomen. Carbon dioxide is then passed through the small tube, into the abdominal cavity to lift the abdominal wall away from the organs below. This space leaves your surgeon with a better view and a more operating space. Also through the small incision made above your belly button, a laparoscope, which is connected to a video camera, is passed into the stomach. The images generated by the laparoscope are projected onto the video monitors placed near the operating table. Before the commencement of the surgery, your surgeon will inspect your abdominal cavity to be sure that laparoscopy will be safe for you. In cases of infections, adhesions (scar tissue), or any unsuspected or widespread abdominal disease laparoscopic surgical technique might not be done. If after the inspection, your surgeon decides that a laparoscopic surgical technique can be safely performed, four to five extra small incisions will be made, and instruments called trocars and cannulas are inserted through the incisions. These incisions give your surgeon enough access to the abdominal cavity in order to perform laparoscopic surgery. To correct a gastro-oesophageal reflux disease, GERD, the surgeon reduces the hernia (by returning the stomach into the abdomen), and wraps the upper part of the stomach (known as the fundus) around the lower portion of the oesophagus. This reinforces the lower oesophageal sphincter to prevent food reflux into the oesophagus. To conclude, your surgeon will check that there are no areas of bleeding, rinse out the abdominal cavity, and close the small incisions made.

Aftermath of a laparoscopic antireflux procedure.

After the surgery, patients are encouraged to engage in light activity and avoid heavy lifting or strenuous activity for a period of time, which will be determined by your surgeon. Mild post-operative pain may be experienced. Although some patients may require pain relief medication for a short period of time. After laparoscopic antireflux surgery, antireflux medication is usually no longer required. You may temporarily have your diet modified. You should discuss with your surgeon about dietary restrictions after the operation. Within a short amount of time, you will be able to get back to your normal activities, such as showering, working, driving, walking upstairs and lifting. You should schedule a follow-up appointment within 2 weeks of operation.

What complications can occur?

Laparoscopic surgery is largely considered safe. However, just as with any operation, complications may occur. Likely complications may include but not limited to:
  • An adverse reaction to general anaesthesia.
  • Bleeding or bruising associated with the skin incisions.
  • An injury to the oesophagus, spleen, liver, lung lining, stomach or internal organs, which may lead to leakages from this area.
  • An infection of the skin incisions, abdomen, or blood.
  • Other less common complications may also occur.


How long does recovery take?

It usually doesn’t take long. You are discharged immediately after the laparoscopic surgery to go home. However, you will be advised to stay away from heavy duty activities for about 2 o 3 weeks. Also, you may be advised not to drive for the next 7 to 10 days after the surgery.

Why should someone have laparoscopic surgery?

You should consider laparoscopic surgery if you desire to be free from long term medication. Also, you should consider laparoscopic surgery when attempts to fully control reflux symptoms with adequate doses of medication fails or you start experiencing side effects of medications, such as itchy skin, joint pains, diarrhoea and bloating 

What are the probable side effects?

There may be a couple of side effects of a laparoscopic antireflux surgery such as difficulty in swallowing, feeling full, bloating, flatulence, weight loss, and small risk of complications.

How efficient a laparoscopic surgery?

Laparoscopic antireflux surgery is found to have improved or eradicated heartburn and regurgitation in more than 90% of patients. And in a number of studies surgical patients were asked if they would do a laparoscopic surgery all over again. 85-90% of them said they would.

Who can have laparoscopic antireflux surgery done?

Laparoscopic antireflux surgery is mostly appropriate for those who have not had previous abdominal surgery, those who experience most of reflux symptoms when lying down and those who have small a hiatal hernias without complications of GERD.

What is gastro oesophageal reflux (GERD)?

Gastro oesophageal reflux disease, known simply as GERD, is a digestive disorder that affects the muscular ring (that is, the lower oesophageal sphincter) connecting the oesophagus with the stomach. The sphincter usually prevents food from moving out of the stomach and back up into the oesophagus.