Anti-reflux surgery is aimed at curing the symptoms of acid reflux.
Drugs that lower the acid content in the stomach are effective at controlling symptoms and healing inflammation, but surgery is recommended when the symptoms continue or if you feel that you would prefer not to stay on medication.
WHAT DOES ANTI-REFLUX SURGERY ENTAIL?
This operation is nearly always achieved using keyhole techniques (laparoscopic surgery). Compared to open surgery, which involves a larger incision, the laparoscopic method leads to a speedier recovery and less post-operative pain.
Most patients have a hiatus hernia associated with their reflux disease and repair of this hernia is undertaken at the same time as anti-reflux surgery. The hernia sac is pulled down from the chest and stitched so that it remains within the abdomen. Additionally the opening in the diaphragm, through which the oesophagus passes from the chest into the abdomen, is tightened.
During the procedure the part of the stomach that is closest to the entry of the oesophagus (the fundus of the stomach) is gathered, wrapped and stitched around the lower end of the oesophagus. This procedure increases the pressure at the lower end of the oesophagus and thereby reduces acid reflux. This wrap (or fundoplication) produces a kind of one-way valve from the oesophagus to the stomach. It is because the operation prevents reflux from the stomach into the oesophagus that we call the procedure ‘antireflux surgery’.
The operation usually takes between 1 and 1½ hours.
WHAT ARE THE COMPLICATIONS?
You should be able to go home within a few days and return to work after three to four weeks but this may vary depending on the extent of surgery and your type of work.
Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, you should ask a member of the healthcare team or your GP for advice. You should make a full recovery, with the symptoms of acid reflux gone or much improved.
As with all surgical procedures, there may be side-effects although these are very rare. They can include:
- Difficulty swallowing
- Bloating and flatulence
- Feeling full
- Weight loss
- Small risk of complications
Mr Hollowood and Mr Wilkerson regularly perform anti-reflux surgery and have extremely good outcomes.
RECOVERY AFTER ANTI-REFLUX SURGERY
After first time keyhole anti-reflux surgery, most patients will stay in hospital overnight. Assuming soft foods like porridge or wet Weetabix textures are swallowed without difficulty, you can go home the following day.
There are three main issues to consider in your recovery from this operation. First, is the immediate recovery to normal daily activities. We anticipate you will be able to be up and about, walking around as normal from day 1 post-operatively You will have some upper abdominal discomfort and pain behind the breast bone that will require regular simple pain relief for up to a week. You should not attempt to drive during this period, and should consult your insurer after a week to confirm your policy is still valid.
Second, is the impact on your swallowing. Due to the inflammation around the surgery site, it is almost invariable that you will struggle to swallow textures such as bread or meat in the first 4-6 weeks. This is normal and should be expected and planned for, with appropriate foods available at home during this time. We advise you to stick to soft textures for at least 4 weeks. This could include porridge or Weetabix as above, or scrambled eggs, mashed potato, mince or fish with a sauce etc. You should definitely avoid all un-minced meat/poultry, bread products and ensure any vegetables you eat are soft. In some cases, the difficulty swallowing can extend for a longer period. We will discuss with you if any further intervention is needed at your follow up appointments.
Finally, is the healing of the repair to the diaphragm. The gap in the diaphragm that the gullet passes through will have been reinforced with sutures during your operation and like any other hernia repair, this needs to heal before being placed under stress. Our anaesthetic colleagues will take measures to minimise the risk of post-operative nausea and vomiting. You should avoid lifting anything heavier than a full family-sized kettle for 4 weeks. Strenuous activity that causes heavy breathing should also be avoided if possible, including any form of exercise like running, swimming or cycling, again for 4 weeks. Walking any distance is absolutely fine. After 4 weeks, you can start to gently re-introduce exercise activities, building up to normal intensity at 6 weeks.