GERD & anti-reflux surgery

Gastroesophageal reflux disease (GERD) is a chronic condition where stomach contents reflux into the esophagus, leading to mucosal damage. Long-standing and untreated GERD can result in serious complications, including Barrett’s esophagus and esophageal adenocarcinoma.

Barrett’s in some is a pre-cancerous lesion and it accounts for more than 95% of cases of oesophageal adenocarcinoma (OAC). However, the cancer risk is lower than previously believed. The incidence in patients with non-dysplastic Barrett’s is low at between 0.1% to 0.3% per year. So, the majority of Barrett’s patients will never develop OAC. Much effort has been made to try to define these high-risk patients likely to progress to OAC and effective preventive measures

? Summary of Risk Progression
Condition Estimated Annual Risk of Progression to Cancer:
– GERD without Barrett’s Very low (but higher than general population)
– Barrett’s (no dysplasia) ~0.1–0.3% per year
– Low-grade dysplasia ~0.7–1% per year
– High-grade dysplasia ~7–10% per year

? Clinical Importance
GERD is more than just heartburn — chronic untreated GERD increases cancer risk.
Surveillance endoscopy is recommended for patients with Barrett’s esophagus to detect early dysplasia or cancer.
Anti-reflux treatment (PPIs, surgery) may reduce inflammation and possibly progression risk but does not reverse Barrett’s.

https://vimeo.com/51589652

What is Anti-Reflux Surgery?

Fundoplication is a procedure used to relieve Gastro-Esophageal Reflux Disease (GERD) and its associated symptoms of heartburn and regurgitation of acid stomach contents.

The operation involves repairing any hiatus hernia which might be present, and then using part of the upper stomach (fundus), to wrap around the lower part of the oesophagus.

This creates a ‘valve between the oesophagus and the stomach, to prevent acid from the stomach refluxing into the oesophagus.

Type of Fundoplication

The type of fundoplication is determined by the amount of degrees the stomach is wrapped around the oesophagus:

Nissen=360°
Partial=90°
Posterior=270°
Anterior=180°

Your surgeon will determine which fundoplication will be appropriate for your condition.

Using part of gastric wall as anterior partial fundoplication to wrap onto the lower esophagus as anti reflux surgery

Laparoscopic Fundoplication

Laparoscopic method- 5 very small incisions are made. A Laparoscope is inserted through the incisions. This method takes approximately 1- 2 hours to complete.

Preparation required for Fundoplication?

Do not eat or drink 6 hours prior to surgery
Removed all jewellery and nail polish prior to attending hospital
If you are taking blood thinning medication, you need to stop the medicine 7 days prior to your procedure
Understand the side effect of anti-reflux surgery, post op care and diet

Risks

While laparoscopic surgery is generally safe, it carries potential risks, including:

Infection
Bleeding
Damage to nearby organs such as the stomach, esophagus, or vagus nerve
Anesthesia complications
Recurrence of the hernia
Difficulty swallowing (dysphagia) if the wrap is too tight
Gas bloat syndrome, which can make it difficult to burp or vomit

Side Effects

Common side effects include temporary discomfort or pain at the incision sites, bloating, and changes in bowel habits. Most side effects are mild and improve over time. However, some patients may experience long-term changes in digestion or swallowing.

Recovery

Recovery from laparoscopic hiatal hernia repair and fundoplication typically involves:
A hospital stay of 1-3 days
Return to light activities within a week, with full recovery and return to all activities within 4-6 weeks
A special diet starting with liquids, gradually moving to soft foods, and then to a normal diet as tolerated
Avoiding heavy lifting or strenuous activities for 6-8 weeks after surgery to prevent recurrence

It’s important for patients to follow post-operative instructions closely, including dietary recommendations and follow-up appointments, to ensure the best outcome and manage any potential complications.

Always discuss these details in the context of the individual patient’s health status and any specific concerns or conditions they may have. This conversation is key to ensuring that the patient is fully informed and comfortable with the procedure.

Dietary Protocol for Laparoscopic fundoplication

Day of Surgery Post-op

Free fluids
No Fizzy drinks
Post-op Day 1
Liquidised or Blended Small frequent meals
No bread / pasta
No Fizzy drinks

Day 2

Minced / Fork mash Small frequent meals
No bread / pasta
No Fizzy drinks

Day 3

Soft Small frequent meals, minced meat only
No red meat / bread / pasta
No Fizzy drinks

Important: If you feel nauseous, please ask for anti-emetic medication

Dietary Modification: The dietitian will discuss with you the necessary dietary modifications which will be required during the first four to six weeks after your surgery. This will involve:
1. Continuing to eat very soft foods, in the form of small meals and snacks, taken more often, for three months after surgery. You should avoid eating hard bulky foods that need to be chewed over and over again, because these will have difficulty passing through the oesophagus into the stomach. Foods such as bread, pasta, red meat / steak, oranges and celery, should be particularly avoided, because these may become ‘stuck’ in the lower oesophagus. The dietitian will discuss this with you in more detail.
2. Avoid carbonated or fizzy drinks such as coke, lemonade or beer, because you may not be able to belch to relieve gas. You should discuss with surgeon whether you need to avoid these drinks indefinitely, or when you can recommence these drinks

Physical Activity You should be able to return to light duties of work within one week, and progress to resuming your usual activities and work about two weeks after surgery. However, it is important that you do not lift any heavy objects, or undertake any activity that puts a strain on the abdomen for at least 6-8 weeks after surgery.

GERD & Anti-reflux Surgery