Laparoscopic Fundoplication Surgery Mumbai
Medical Gastroenterologist may refer a patient of GERD or Heart Burn or hiatal hernia to a GI Surgeon for operation when medical treatment fails. With the advent of laparoscopic surgery in India, Laparoscopic Fundoplication Surgery or Laparoscopic Anti-Reflux Surgery or Nissen fundoplication is best surgical option available for resistant GERD and large Hiatus hernias.
Dr Nitish Jhawar is senior laparoscopic surgeon with 17 years’ experience in the field and fellowship in advance laparoscopic surgery. He is among those surgeons who perform Laparoscopic fundoplication surgery in Mumbai.\
What is Heart Burn or GERD ?
The lower end of the esophagus (LES) works as a one-way valve allowing food to pass from the food pipe to the stomach but prevents the highly acidic stomach juices from going back into the food pipe (reflux).
When LES is weak or lax, it results in reflux of stomach acids causing stinging, burning sensation in the throat and chest, a condition known as GERD (Gastro-Esophageal Reflux Disease) Repeated reflux may lead to inflammation and damage to the esophagus. Some individuals are predisposed to LAX LES. Bad diet, smoking, alcohol, or certain body postures – all can lead to GERD.
What is Hiatus Hernia?
The esophagus passes from the chest to the abdomen through an opening in the diaphragm (esophageal hiatus). This opening is usually just adequate for passage of the esophagus. However, patients that have a hiatal hernia have an enlarged opening. A hiatal or diaphragmatic, hernia occurs when the lower part of the esophagus and a portion of the stomach slide up through this esophageal hiatus into chest cavity.
There are four different types of hiatal hernias and sliding hernia is the most common of the four representing more than eighty-percent of all hiatal hernias
Sliding hiatal hernias are those in which the junction of the esophagus and stomach, and part of the stomach protrude into the chest.
Para-esophageal hernias are hernias in which the gastro-esophageal junction stays where it belongs but part of the stomach passes or bulges into the chest beside the esophagus. The para- esophageal hernias themselves remain in the chest at all times and are not affected by swallows.
Symptoms & Diagnosis Of Hiatal Hernia
- Heartburn – 30-60 minutes after eating
- Regurgitation – more with lying flat
- Excessive belching
- Aspiration – reflux of stomach contents into the airway
- Chronic cough or Asthma – because of chronic aspiration
- Mid Chest Pain
- Difficulty or pain with swallowing
- Symptoms of obstruction
- Hiatal hernias are diagnosed incidentally when an upper gastrointestinal x-ray or endoscopy is done.
- Chest X-ray:
- Esophagogram (Barium UGI)
- Upper GI Endoscopy (EGD)
- Esophageal Manometry
What are the Treatment Options for GERD ?
Mild GERD may be treated with modified diet, quitting smoking and drinking, regular exercises and better sleeping habits. Along with life style modifications, medicines such as antacids and anti reflux medicines can be prescribed.
When all that fails, then the next logical step is surgery.
Large para esophageal hernias causing symptoms requires surgery. Repair will help prevent complications such as bleeding, intestinal disruption, strangulation.
Treatment of sliding hiatal hernias is usually the same as for the GERD.
Surgical Procedure for GERD /hiatal hernia
Laparoscopic Fundoplication or laparoscopic anti reflux surgery is best surgical option available for large hiatal hernia and for failed medical treatment of GERD.
The stomach and lower esophagus are placed back into the abdominal cavity. Hernia defects greater than 5 cm. are buttressed with mesh which significantly decreases the recurrence rate.
The opening in the diaphragm (hiatus) is tightened and the stomach is stitched in position to prevent reflux.
The upper part of the stomach (fundus) may be wrapped around the lower end of esophagus (Fundoplication) to prevent reflux.
Advantage of Laparoscopic Fundoplication surgery
Open surgery involves a large incision, a week or more of hospital stay and pain. However, with advanced laparoscopy the same procedure can be done as a day-care surgery with only small holes over the stomach, no pain and it is much safer than the open surgery having a faster recovery to normal activities.
Due to obesity or pre-existing conditions, the laparoscopic method may not be suitable for few patients. During the surgery, the Surgeon may take a decision to do the “open procedure,” strictly based on the safety of the patient.
Preparation for Laparoscopic Anti -Reflux Surgery
Blood Work, Medical Evaluation, Chest X-Ray and an ECG.
- Drink clear liquids, for 2-3 days prior to surgery.
- After midnight the night before the operation, you should not eat or drink anything
- Drugs such as aspirin, blood thinners, anti-inflammatory medications and Vitamin E are to be stopped a week prior to surgery.
- Quit smoking
Recovery After Laparoscopic Fundoplication Surgery
- Patients are started on clear liquids the next morning and are discharged in the afternoon.
- Soft food is given for 4-6 weeks after surgery.
- Patients are encouraged for early ambulation and light activity after surgery.
- Post-operative pain is generally mild for which pain medication may be given.
- Anti-reflux medication is usually not required after surgery.