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GERD Surgery - Fundoplication
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There are different ways of performing a GERD Surgery, but the focus of this article will be on Fundoplication.
Dr Kan is experienced in all of the following:
- Nissen’s fundoplication. This is when your surgeon wraps the top part of your stomach all the way around the lower part of your oesophagus.
- Partial fundoplication. In this type, your surgeon wraps your stomach just part of the way around your oesophagus. These techniques includes Dor (anterior 180° – 200°) and Toupet (posterior 270°).
In this post, we’ll be focusing on the topic of Laparoscopic Nissen fundoplication
Laparoscopic Nissen fundoplication is currently the ‘gold-standard’ for treating GERD in patients who don’t respond completely to medications or can’t take medications. Laparoscopic Nissen fundoplication is the most commonly performed procedure in treating anti-reflux.
During the Nissen fundoplication, the upper part of the stomach is wrapped around the LES (lower oesophageal sphincter) to strengthen the sphincter, prevent acid reflux, and repair a hiatal hernia. This essentially repairs the valve at the end of the oesophagus that doesn’t work properly in patients with GERD. As opposed to medications for GERD, surgery stops all types of reflux, including digestive enzymes and acid. Because of this, surgery can cure reflux like medications can’t. If a hiatal hernia is present, this is fixed at the same time as the Nissen fundoplication.
What is a laparoscopic Nissen fundoplication?
Laparoscopic Nissen fundoplication is a minimally invasive (keyhole) procedure that restores normal functioning in your body’s natural reflux barrier (lower oesophageal sphincter).Laparoscopic Nissen fundoplication is currently the ‘gold-standard’ for treating GERD in patients who don’t respond completely to medications or can’t take medications for another reason.
Laparoscopic Nissen fundoplication is also the most commonly performed anti-reflux procedure. As a laparoscopic procedure, Nissen fundoplication involves using specialized tools inserted through very small incisions above your belly button (laparoscopy).During surgery, the top of the stomach (the fundus – hence the term fundoplication) is wrapped around the bottom of the oesophagus. This essentially repairs the valve at the end of the oesophagus that doesn’t work properly in patients with GERD.
How does Fundoplication Surgery work?
During a Nissen fundoplication, the upper portion of the stomach is wrapped around the LES (lower oesophageal sphincter). This procedure is done to strengthen the LES, prevent acid reflux, and repair a hiatal hernia. This essentially repairs the valve at the end of the oesophagus that doesn’t work properly in patients with GERD.
As opposed to medications for GERD, surgery stops all types of reflux, including digestive enzymes and acid. Because of this, surgery can cure reflux like medications can’t. If a hiatal hernia is present, this is fixed at the same time`.
You may ask “what is GERD?”
GERD is a digestive disorder where stomach acid frequently flows back into the tube connecting your mouth and stomach. This backwash (acid reflux) can irritate the lining of your oesophagus, causing discomfort and other symptoms. If GERD is severe and medicine or lifestyle changes cannot provide relief, the doctor may recommend surgery called fundoplication.
What to expect with Nissen Fundoplication Surgery?
Before the Surgery:
- You won’t be allowed to eat or drink anything from midnight before your surgery.
- Stop aspirin and any other blood thinning medication per your doctor’s advice.
During the Surgery:
- The procedure is performed under general anaesthesia.
Your surgeon will make several small incisions (around 5mm) to insert a laparoscope (a thin tube with a camera attached) and other surgical instruments into your abdominal cavity. The laparoscope allows for better visualisation throughout the surgery while minimising any trauma to surrounding tissue. - The duration of the surgery will vary from patient to patient.
After the Surgery:
- After waking up from anaesthesia, you may feel some discomfort in your chest or throat. This is due to the gas that was used during surgery. This is normal and will resolve within a few days.
- You may be discharged from the hospital on the same day or asked to stay in the hospital overnight.
- Avoid heavy lifting.
- Your surgeon will provide you with specific instructions on dietary plan.
Benefits of Laparoscopic Nissen Fundoplication
Laparoscopic Nissen fundoplication has been shown to have multiple benefits compared to other anti-reflux procedures. These include:
- Minimally invasive surgery with smaller incisions and faster recovery time.
- High success rate in controlling symptoms of GERD, including eliminating or reducing the need for medications.
- Decreased risk of complications such as infection and bleeding during surgery.
- Significant improvement in quality of life for patients suffering from GERD.
What are the results of laparoscopic Nissen fundoplication?
When performed by an experienced surgeon, the results of GERD surgery are excellent. Patients suffering from GERD should expect that their quality of life will be significantly improved after this procedure. Most patients are also able to stop taking acid-suppression medication and can also typically expect to be discharged the day after the procedure.
What are the side effects of Laparoscopic Nissen Fundoplication?
After undergoing laparoscopic Nissen fundoplication surgery, patients can expect to experience some side effects and have certain restrictions. These may include:
Patients may experience dumping syndrome or ongoing reflux after the procedure. Dumping syndrome occurs when food moves too quickly from the stomach to the small intestine. Reflux may persist even if the procedure is done correctly.
However, these side effects are uncommon and can often be managed through dietary changes or medication if necessary. It is important to discuss any concerns with your surgeon before undergoing the surgery.
- A sore throat for a few days due to the intubation during the surgery.
- Swallowing difficulties or discomfort in swallowing for up to 2 weeks, as the new valve is adjusting.
- Bloating or gas buildup in the abdomen, which should subside over time.
- Nausea and vomiting, which can be managed with medication.
- Diarrhoea or constipation may occur temporarily due to changes in diet and medications.
- Limitations on physical activities and lifting heavy objects for at least two weeks after surgery.
- A liquid-only diet immediately after the surgery followed by gradually introducing soft foods and then solid foods over time.
Patients may experience dumping syndrome or ongoing reflux after the procedure. Dumping syndrome occurs when food moves too quickly from the stomach to the small intestine. Reflux may persist even if the procedure is done correctly.
However, these side effects are uncommon and can often be managed through dietary changes or medication if necessary. It is important to discuss any concerns with your surgeon before undergoing the surgery.
What are the possible complications of Laparoscopic Nissen fundoplication surgery?
Serious complications after laparoscopic anti-reflux surgery are rare. However, should you be keen to find out more on the risks, options, and alternatives to laparoscopic Nissen fundoplication, please make an appointment with our acid reflux surgeon Dr Kan Yuk Man.
Post-Laparoscopic Nissen Fundoplication Surgery Care
After the surgery, it is important to follow some post-operative care instructions to ensure proper healing and recovery. These may include:
It is also important to note that you may experience some discomfort or bloating in the chest or shoulder area after the surgery, which is normal and should subside within a few days. If you experience persistent pain, fever, difficulty swallowing, or other concerning symptoms, be sure to contact your surgeon immediately.
- Prioritising rest and limiting physical activity for a few days after the surgery
- Avoiding heavy lifting and strenuous exercise for several weeks following the surgery
- Taking prescribed medications as directed by your surgeon, including pain medication and acid suppressants if needed
- Keeping the incision sites clean and dry to prevent infection
- Attending follow-up appointments with your surgeon to monitor progress and address any concerns
- Adhere to a liquid or soft food diet for the first two weeks post-surgery. Gradually introduce soft to light solid foods during the third and fourth weeks. You may resume your regular diet one month after surgery. However, it is advisable to avoid foods prone to getting stuck in your oesophagus, such as steak, bread crusts, and raw fruits, for 8-12 weeks post-surgery.
It is also important to note that you may experience some discomfort or bloating in the chest or shoulder area after the surgery, which is normal and should subside within a few days. If you experience persistent pain, fever, difficulty swallowing, or other concerning symptoms, be sure to contact your surgeon immediately.
How long does it take to recover from Anti-Reflux surgery?
The recovery time for laparoscopic Nissen fundoplication varies from person to person. But most patients are able to resume their normal activities within two weeks. Follow your surgeon’s instructions and attend all follow-up appointments to ensure proper healing and recovery.
The surgery may take a few months to fully show its benefits. This is because the body needs time to heal and adjust. After laparoscopic Nissen fundoplication surgery, many patients can find long-term relief from GERD symptoms with proper care and lifestyle changes. However, it is still important to maintain a healthy diet and exercise regularly in order to maintain good digestive health.
Why Choose Us For Your Fundoplication Surgery?
Dr Kan is an expert in GERD surgery, he also has extensive experience in laparoscopic nissen fundoplication surgery. He is skilled in performing this procedure using minimally invasive techniques, resulting in less pain and a faster recovery time for patients.
If you are suffering from GERD and have been recommended for anti-reflux surgery, make sure to consult with an experienced surgeon like Dr Kan who can provide you with the best treatment options and results.
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