Anti-Reflux Surgery

Anti-Reflux Surgery is surgery performed for Gastro-Oesophageal Reflux Disease, which is when food and/or acid travels from the stomach back up into the oesophagus (gullet). The operation may also be called a Fundoplication, Nissen Fundoplication or Toupet Fundoplication.

Currently the vast majority of anti-reflux surgery is performed laparoscopically.

Laparoscopic or keyhole surgery has many benefits compared to traditional methods of anti-reflux surgery involving large incisions. Benefits include shorter hospital stay, reduced risk of organ injury, wound infection and reduced post-operative pain.

The principle of anti-reflux surgery is to restore and reinforce the normal anti reflux mechanisms at the junction of the oesophagus (gullet) and the stomach.

Types of Fundoplication

There are many difference techniques described for performing a fundoplication. As such the operation can have multiple descriptions such as Nissen, Toupet, Watson and Dor.

The main difference between these techniques is related to the degree of which the upper part of the stomach is wrapped around the oesophagus. Descriptions range from a partial 90 degree wrapping of the stomach to a full 360 degree wrap (Nissen fundoplication).

In general the literature suggests the more “aggressive” the wrap, the trend toward better reflux control. However more “aggressive” wraps can be associated with unwanted consequences such as swallowing difficulties.

Longer term reflux control appears similar amongst the different techniques.

Before Fundoplication Surgery

Fundoplication surgery is general safe with a low complication rate. Steps may be advised by Dr Manley for you to take prior to surgery to make it safer including;

Advising pre operative weight loss
Commencing a low calorie diet with a meal substitute such as optifast 2-3weeks prior to surgery. The effect of this is to decrease the bulkiness of the liver and improve the surgical view, making the operation safer

Fundoplication Procedure

Fundoplication is performed under general anaesthesia and most patients stay 1-2 nights in the hospital.

Steps involved in the Fundoplication procedure include:

Your surgeon makes five small incisions in the upper abdomen and inserts a telescope and a number of other instruments into the abdomen. The procedure is done by watching a monitor.
If there is a hiatus hernia present then this is corrected and the stomach returned to the normal position in the abdominal cavity prior to fundoplication
The hole in the diaphragm through which the oesophagus passes is then tightened with sutures.
The top part of the stomach (fundus) is gently freed from the surrounding organs and then wrapped around the lower part of the oesophagus and stitched into position. (fundoplication) This then reduces the ability of food and fluid to travel back up into the oesophagus.
The laparoscope and other instruments are removed and the gas released.
Local anaesthetic blocks are used to reduce post-operative discomfort
The tiny incisions are then closed.

After Fundoplication Surgery

After the surgery,

Wound Care

Care should be taken with your wound.
Waterproof dressings are applied so you can shower
They should be removed after 5 days.

Pain Management

You may feel soreness around the incision areas.
Your surgeon may give you prescription pain medicine or recommend non-steroidal anti-inflammatory drugs (NSAIDs) for the first few days to keep you comfortable.
you may experience discomfort in the abdomen, chest, or shoulder area for a couple of days either due to the gas from surgery or internal sutures.

Diet

Your surgeon will instruct you about your diet and activity restrictions. Dietary restrictions are progressively lifted and usually unrestricted within 6 weeks following the surgery

Activity

Shortly after surgery, you can gradually resume your daily activities,
You are encouraged to start walking as early as possible to reduce the risks of blood clots and pneumonia, and
You are advised not to lift heavy objects for 4-6 weeks.

Work

You will be able to get back to work usually within 2 weeks.

Contact your doctor immediately if you have a fever, chills, increased pain, bleeding or fluid leakage from the incisions, chest pain, shortness of breath, leg pain or dizziness.

Almost all patients have a major reduction and great improvement or complete cessation in symptoms after surgery. Most will be able to cease taking antireflux medication immediately. There is a short transition onto normal diet however within 6 weeks your diet should return to normal.