Gastro-Oesophageal Reflux Disease (GORD)
The Surgical Treatment Option
Reflux (GORD)
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
An objective diagnosis of GORD involves:
- 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 to look for abnormalities of the
oesophagus or stomach and exclude other conditions in the lower stomach or
duodenum. 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 .
Barrett's Oesophagus: This is a condition where severe irritation and ulceration of the lining of the gullet (oesophagus) causes changes to the cells in the lower oesophagus and can lead to the development of the first stage of cancer. There is currently no evidence that anti reflux surgery either cures Barrett’s or prevents cancer of the lower oesophagus. However if a patient is suffering from Barrett’s this is an indication that their reflux has been severe enough to consider surgery as an option.
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
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).
In some cases open surgery, called a laparotomy, may be necessary, particularly if the patient has previously had upper abdominal surgery. While open surgery is safe and effective, patients usually take longer to recover and spend more time in hospital.
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
Mr. Michael Bickford FRACS has 10 years experience in the surgical management
of patients with poorly controlled oesophageal reflux. The techniques and
outcomes are reviewed continuously and can be discussed with you at a
consultation.
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 Mr. Michael Bickford. 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 Mr. Michael Bickford’s consulting suites on (03)9210
7277 to make an appointment.
|
