Laparoscopic GI Surgeries

What is GERD?

Gastro Esophageal Reflux Disease (GERD) occurs when acidic stomach connects flow back into the food pipe. It is common to have such a reflux occasionally.

What are the symptoms of GERD?

• A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
• Chest pain
• Difficulty in swallowing
• Regurgitation of food or sour liquid
• Sensation of a lump in your throat

Some people also have significant night time reflux. They may present with :

• Chronic cough
• Laryngitis
• New or worsening asthma
• Disrupted sleep

What are the causes of GERD?

In normal individuals, the reflux of stomach contents is prevented by a circular muscle sling, called the cardia, situated the junction of Esophagus and stomach. In people with GERD, this sling weakens or relaxes abnormally to permit a backwash often irritating the inner lining causing it to get inflamed.

Which individuals are at higher risk of GERD?

Conditions that can increase your risk of GERD include:

• Obesity
• Herniation of stomach into the chest (Hiatus hernia)
• Pregnancy
• Connective tissue disorders, such as scleroderma
• Delayed stomach emptying

Factors that can aggravate acid reflux include:

• Smoking
• Eating large meals especially late at night
• Eating fatty or fried foods
• Drinking alcohol, coffee or carbonated beverages
• Medications such as aspirin

What can happen if I ignore the symptoms?

Chronic inflammation of the Oesophagus causes....

• Narrowing of the esophagus (esophageal stricture) which narrows the food pathway, leading to problems with swallowing.
• A wound in the esophagus (esophageal ulcer) which can bleed, cause pain and make swallowing difficult.
• Precancerous changes to the esophagus (Barrett's esophagus) which is associated with an increased risk of esophageal cancer.

When should I see a doctor?

See a doctor if you:

• Experience severe or frequent GERD symptoms
• Take medications for heartburn more than twice a week

How is GERD diagnosed?

Based on your history and physical examination, suspicion of GERD is aroused. Furthermore, to confirm the diagnosis the following tests may be asked for....

A) Upper GI Endoscopy :It is usually a painless OPD procedure which sees the Oesophagus and Stomach from inside. It can pick up Oesophagitis, hiatus hernia, ulcers or Barrett’s Oesophagus. It can be coupled with a concomitant biopsy to rule out complications.

B) Oesophageal manometry :It is again, a painless OPD procedure where a small catheter inserted orally measures rhythmic contractions and pressures at various levels in the oesophagus as well as at the Oesophago-gastric junction. it is done in almost every case in whom surgery is contemplated.

C) 24 hour pH monitoring :Done mostly in patients with symptoms suspected due to GERD who have not responded to medical treatment.

D) Barium Swallow :it is an X-Ray test done occasionally to document hiatus hernia or narrowing of the Oesophagus.

What is the treatment of GERD?

Initially, your doctor will recommend certain medicines and life style modifications which include...

• Maintain a healthy weight. Excess weight pushes up your stomach and causing acid to reflux into your oesophagus.
• Stop smoking. Smoking weakens the O-G valve.
• Elevate the head of your bed. helps in patients with severe night reflux. Raising your head with additional pillows isn't effective.
• Wait at least three hours after eating before lying down or going to bed.
• Eat food slowly and chew thoroughly.
• Avoid foods and drinks that trigger reflux. Common triggers include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.
• Avoid tight-fitting clothing. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.

Concomitantly medicines to reduce acid production or its ill effects on the oesophagus could be prescribed. Often medicines and lifestyle changes will take care of your symptoms. If not, a surgery may be required.

What is the surgical treatment of GERD?

Fundoplication, almost invariably done via laparoscopy is the treatment of choice in GERD. It involves strengthening the lower Oesophageal sphincter and wrapping of the upper end of the stomach around it to create a new valve like mechanism.
Surgery typically lasts from about 90 mins and involves 4 to 5 tiny cuts on your tummy.

What are the advantages of laparoscopic surgery?

The biggest advantage remains that a thorough survey of the visible parts of the abdominal cavity can be made to rule out other concomitant or mimicking pathologies and treat them simultaneously.
Other advantages include.

• Minimal post-surgical pain.
• Reduced risk of post-surgical infection.
• Shorter hospital stay.
• Early return to work.
• Better cosmetic outcome

Will I be in pain after surgery?

Not really. Principally, it is not a very painful surgery; moreover, painkillers do their job really well.

How early can I go home after surgery?

As early as 24 to 36 hours.

When can I have bath after surgery?

Almost invariably, all your dressings are waterproof permitting you to bathe the very next day.

Will there be tubes put into me?

More often than not, stomach tube or urinary catheter are not put, unless it's a very tough scenario. Very occasionally, tube drains are put inside the abdomen in difficult cases as a safety measure.

Would there be sutures that require a painful removal?

Firstly, suture or staple removal is a totally pain-free procedure. More often, surgical glue will be used to approximate skin wherein removal isn't essential.

How many times do I have to come for follow up after I get discharged?

Usually only once, around the 8th day for a wound check.