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Anti-reflux surgery
/Hiatus hernia
Many people have reflux without knowing it, though up to a quarter of adults experience symptoms or complications of reflux called GORD (“Gastro-oesophageal reflux disease”).
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Symptoms
Symptoms include heart-burn (burning-type pain in the lower middle part of your chest), sour taste in the back of your mouth, regurgitation (bringing food back up into your mouth), difficulty swallowing and occasionally cough, wheeze and changes in your voice. These are a result of movement of the gastric contents up into the oesophagus. This usually occurs due to a defect of the lower oesophageal sphincter and can be associated with a hiatus hernia.
A hiatus hernia occurs when part of the stomach that normally resides within the abdomen slides through the diaphragm into the thoracic cavity (chest).
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What can I do about it?
There are a number of tests that can help determine if you have reflux and/or a hiatus hernia or other conditions that might be giving you the symptoms. These include an endoscopy, manometry, barium-xrays and pH studies.
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How can it be treated?
Antacids (which neutralize stomach acid) and proton-pump inhibitors (like Omeprazole and Pantoprazole) can decrease acid production and provide good relief of reflux symptoms for many people.
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When might Surgery help?
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Patients with chronic reflux with failure of medical treatment to control symptoms.
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Complications from GORD such as inflammation of the oesophagus, oesophageal ulcer, narrowing of the oesophagus, chronic cough, and reflux of fluid into the lungs.
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Patients with both GORD and a large hiatus hernia
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What does surgery involve?
The procedure is called a fundoplication in which the upper part of the stomach is wrapped around the end of your oesophagus and oesophageal sphincter, where it is sutured into place. This surgery strengthens the sphincter and helps prevent stomach content moving back into the oesophagus.
If a hiatus hernia is present, this will be fixed by bringing the stomach back into the abdomen and reducing the opening in the diaphragm to help prevent it moving back up again.