Gastroesophageal reflux disease can be managed both medically and surgically. If medical management (please refer to our brochure, Heartburn and Hiatal Hernia) has not been effective, your doctor may recommend surgery to prevent stomach contents from washing up into your esophagus. This surgery is called a fundoplication. A fundoplication makes a new valve in the area where the stomach connects to the esophagus and closes the defect in the diaphragm. Until recently, this surgery had to be done through a long incision in the abdomen and required a week in the hospital and several weeks at home to recover. Now this operation can be done through the use of laparoscopy, so most patients can go home in one day and return to work or normal activities in approximately one or two weeks.
Before you undergo this surgery, it is necessary to make sure that it is the right procedure for your symptoms, as many conditions can mimic esophageal reflux.
These procedures include
- Upper GI endoscopy to evaluate the lining of the esophagus and the stomach
- Upper GI x-rays to demonstrate the anatomy of the hiatal hernia
- Esophageal manometry to demonstrate proper mechanical function of the esophagus and to confirm a weak lower esophageal sphincter (LES)
- A possible pH probe study to measure the frequency and amount of acid that enters the esophagus
Laparoscopic Surgery is performed under general anesthesia. Your abdomen will be inflated with carbon dioxide gas to provide space in which to work. The laparoscope with an attached camera is inserted through an incision. The camera sends images to a TV monitor. Your surgeon can then view the inside of your abdominal cavity on the video screen. Other incisions are used to accommodate the surgical instruments. During this procedure, your surgeon narrows the defect in the diaphragm and recreates the LES. The surgery usually lasts two hours.
If your surgeon feels that it is not safe to continue with the laparoscopic procedure once the surgery has started, he may complete the operation through a standard incision. This surgery requires a longer recovery time – up to a week in the hospital and four weeks at home.
Following surgery, you will be monitored in the recovery area and then taken to your room. You will be asked to get out of bed and walk that evening. IV fluids are administered until you are able to take liquids by mouth. When you can take liquids well enough, you can be discharged home.
Recovery at Home Once at home you can gradually resume normal activities as you are able. You will be sore from the operation, but most patients do not have severe pain. You will be given a prescription for liquid pain medication. Ask your doctor about swallowing any pills you might usually take.
Swelling of esophagus may produce a feeling of tightness with a little difficulty in swallowing. This gradually goes away but may take up to eight weeks. Some bloating is common. You will start with a thin liquid diet and gradually advance to thicker liquids, semi-solids, and eventually solid foods. Please see our post-op diet sheet for more information. Remember to sit upright at mealtime. Avoid ice-cold or carbonated beverages. Once you start eating solid foods, it is necessary to take small bites and chew your food thoroughly. You may get full from a small portion of food. This will resolve in time. Most patients lose about 10 lbs while recovering from surgery.
Remember that although it appears as though you have had a minor operation on the outside, you have had major surgery on the inside. Your body will require time to recover, so be patient. You should follow-up in our office one or two weeks after surgery. Call your surgeon if you have persistent fever over 100.4 F degrees, bleeding, increased abdominal swelling or pain, persistent nausea or vomiting, chills, cough or shortness of breath, or difficulty swallowing liquids.
Complications are rare, but can occur. It is important that you are aware of the common risks and complications of laparoscopic fundoplication. It is possible that one of these complications will result in the need to convert to an open surgery or the need for further surgery.
Complications can include
- Injury to the liver, spleen, esophagus or stomach during surgery
- Bloating (Gas Bloat syndrome)
- Inability to vomit
- Difficulty belching
- Difficulty swallowing
- Failure of the operation to completely eliminate esophageal reflux
- Recurrence of hiatal hernia or reflux
- Disr uption or slippage of the fundoplication
- Increased flatulence
- Anesthetic complications
- Other complications
To view a publication from Austin Surgeons on Laparoscopic Hiatal Hernia Repair, click here