SURGERY FOR “HEARTBURN”
If you suffer from “heartburn” your surgeon may have recommended LAPAROSCOPIC ANTI-REFLUX SURGERY to treat this condition, technically referred to as gastroesophageal reflux disease (GERD). This brochure will explain to you:
WHAT IS GASTROESOPHAGEAL REFLUX DISEASE (GERD)?
Although “heartburn” is often used to describe a variety of digestive problems, in medical terms, it is actually a symptom of gastroesophageal reflux disease. In this condition, stomach acids reflux or “back up” from the stomach into the esophagus. Heartburn is described as a harsh, burning sensation in the area in between your ribs or just below your neck. The feeling may radiate through the chest and into the throat and neck. Many adults in the United States experience this uncomfortable, burning sensation at least once a month. Other symptoms may also include vomiting, difficulty swallowing and chronic coughing or wheezing.
WHAT CAUSES GERD?
When you eat, food travels from your mouth to your stomach through a tube called the esophagus. At the lower end of the esophagus is a small ring of muscle called the lower esophageal sphincter (LES). The LES acts like a one-way valve, allowing food to pass through into the stomach. Normally, the LES closes immediately after swallowing to prevent back-up of stomach juices, which have a high acid content, into the esophagus. GERD occurs when the LES does not function properly allowing acid to flow back and burn the lower esophagus. This irritates and inflames the esophagus, causing heartburn and eventually may damage the esophagus.
WHAT CONTRIBUTES TO GERD?
Some people are born with a naturally weak sphincter (LES). For others, however, fatty and spicy foods, certain types of medication, tight clothing, smoking, drinking alcohol, vigorous exercise or changes in body position (bending over or lying down) may cause the LES to relax, causing reflux. A hiatal hernia (a common term for GERD) may be present in many patients who suffer from GERD, but may not cause symptoms of heartburn.
HOW IS GERD TREATED?
GERD is generally treated in three progressive steps:
LIFE STYLE CHANGES
In many cases, changing diet and taking over-the-counter antacids can reduce how often and how harsh your symptoms are. Losing weight, reducing or eliminating smoking and alcohol consumption, and altering eating and sleeping patterns can also help.
If symptoms persist after these life style changes, drug therapy may be required. Antacids neutralize stomach acids and over-the-counter medications reduce the amount of stomach acid produced. Both may be effective in relieving symptoms. Prescription drugs may be more effective in healing irritation of the esophagus and relieving symptoms. This therapy needs to be discussed with your surgeon.
Patients who do not respond well to lifestyle changes or medications or those who continually require medications to control their symptoms, will have to live with their condition or may undergo a surgical procedure. Surgery is very effective in treating GERD.
There are procedures being tried, known as Intraluminal Endoscopic Procedures, which are alternatives to laparoscopic and open surgery. You will need to discuss with your surgeon and physician whether you are a candidate for any of these procedures.
WHAT ARE THE ADVANTAGES OF THE LAPAROSCOPIC METHOD?
The advantage of the laparoscopic approach is that it usually provides:
ARE YOU A CANDIDATE FOR THE LAPAROSCOPIC METHOD?
Although laparoscopic anti-reflux surgery has many benefits, it may not be appropriate for some patients. Obtain a thorough medical evaluation by a surgeon qualified in laparoscopic anti-reflux surgery in consultation with your primary care physician or gastroenterologist to find out if the technique is appropriate for you.
WHAT TO EXPECT BEFORE LAPAROSCOPIC ANTI-REFLUX SURGERY:
WHAT TO EXPECT THE DAY OF SURGERY:
HOW IS LAPAROSCOPIC ANTI-REFLUX SURGERY PERFORMED?
WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED OR COMPLETED BY THE LAPAROSCOPIC METHOD?
In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. Factors that may increase the possibility of converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, or bleeding problems during the operation. The decision to perform the open procedure is a judgement decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgement. The decision to convert to an open procedure is strictly based on patient safety.
WHAT SHOULD I EXPECT AFTER SURGERY?
ARE THERE SIDE EFFECTS TO THIS OPERATION?
Studies have shown that the vast majority of patients who undergo the procedure are either symptom-free or have significant improvement in their GERD symptoms. Long-term side effects to this procedure are generally uncommon.
WHAT COMPLICATIONS CAN OCCUR?
Although the operation is considered safe, complications may occur as with any operation. Complications may include but are not limited to:
Your surgeon may wish to discuss these with you. (S)He will also help you decide if the risks of laparoscopic anti-reflux surgery are less than non-operative management.
WHEN TO CALL YOUR DOCTOR
This brochure is not intended to take the place of your discussion with your surgeon about the need for laparoscopic reflux surgery. If you have questions about your need for surgery, your alternatives, billing or insurance coverage, or your surgeon's training and experience, do not hesitate to ask your surgeon or his/her office staff about it. If you have questions about the operation or subsequent follow-up, please discuss them with your surgeon before or after the operation.