Heartburn is a common condition. In the pure medical sense, it is caused by stomach contents going back up into the esophagus, which is called gastrointestinal esophageal reflux disease (GERD). The stomach contains acid and enzymes, which cause inflammation to the lining of the esophagus. Other symptoms can be chest pain, vomiting, hoarseness, chronic cough (especially at night), and asthma. Some patients have a hiatal hernia, as well. Treatments include lifestyle changes, medication, or surgery. If your symptoms cannot be controlled with medicine, consider visiting Dr. Thoman to learn about laparoscopic heartburn (GERD) surgery in Santa Barbara, California.
What causes GERD?
The most common reason for patients to develop heartburn or other symptoms of GERD is a defective lower esophageal sphincter (LES). The LES is a complex valve system at the lower end of the esophagus which, when functioning properly, prevents the acid and enzymes of the stomach from going up into the esophagus. There are other reasons for reflux that must be identified before visiting us for laparoscopic GERD surgery. In general, symptoms are directly related to the amount of reflux present. This can be measured by preoperative tests. A hiatal hernia is frequently present in patients with GERD, and, if present, is repaired at the same time.
How is laparoscopic surgery for GERD performed?
Dr. Thoman performs GERD surgery using a minimally-invasive, laparoscopic technique. The laparoscope is a fiber-optic telescope that is connected to a high-resolution video camera. The images from the laparoscope are projected onto a television monitor viewed by the surgeon in the operating room. There are 5 tiny 1/4-inch incisions made in order to complete the surgery. The abdomen is inflated with carbon dioxide gas to allow the surgeon an optimal view of the abdominal cavity and the area to be repaired. The gas is removed at the end of the procedure. The top part of the stomach is wrapped around the lower end of the esophagus (fundoplication). This produces an effective valve mechanism that stops the reflux of gastric contents into the esophagus. The small incisions are closed with absorbable sutures. If a hiatal hernia is present, it is repaired at the same time.
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What can I expect after GERD surgery?
Patients are able to drink fluids the day after their laparoscopic procedure, and they will be out of bed walking the same evening. The majority of patients get pain relief with oral medication. The patient is usually discharged from the hospital the day after surgery. They must stay on a soft diet for 2 weeks to allow better healing. Most patients can then stop their antacid medication permanently. Around 5% of people have difficulty swallowing after surgery, which can last weeks and may require an endoscopy to improve. Around 30% will have bloating after surgery that typically improves over the first few months.
What are the benefits of laparoscopic surgery for GERD?
The benefits of this procedure include:
- Surgery requires only 5 small incisions (1/4 inch), which cause less pain than 1 large abdominal incision.
- The patient is discharged the day after surgery 99% of the time.
- Most patients are back to normal activity within 10 days to 2 weeks.
- The operation is effective in relieving symptoms in approximately 95% of patients.
Am I a candidate for Laparoscopic surgery for GERD?
If you have symptoms that are not controlled with medication, or you wish to eliminate the need to take medication for the rest of your life, you may be a candidate. Depending on your symptoms you may need to have an endoscopy performed, or other tests prior to surgery. Results from inexperienced surgeons has tempered many physicians enthusiasm for this procedure, however, when performed properly it is over 90% effective. Dr. David Thoman, FACS, is a specialist who has specific understanding of the anatomy and mechanics of the gastroesophaegeal junction. His impressive results can be found in the articles below.
- Laparoscopic antireflux surgery and its effect on cough in patients with gastroesophageal reflux disease. Thoman DS – Journal of Gastrointestinal Surgery – 01-JAN-2002; 6(1): 17-21.
- Wisbach G, Peterson T, Thoman D. Early results of the use of acellular dermal allograft in type III paraesophageal hernia repair. Journal of the Society of Laparoscopic Surgeons 2006; 10(2): 184-187
- Quality of life after antireflux surgery compared with non-operative management for severe gastroesophageal reflux disease. Fernando HC – Journal of American College of Surgeons – 01-JAN-2002; 194(1): 23-7
- Five-year comprehensive outcomes evaluation in 181 patients after laparoscopic Nissen fundoplication. Anvari M – Journal of American College of Surgeons – 01-JAN-2003; 196(1): 51-7; discussion 57-8; author reply 58-9
- Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia. Terry M – Surgical Endoscopy – 01-JUL-2001; 15(7): 691-9