Antireflux surgery

Gastroesophageal reflux disease (GERD), esophageal hernia, verified Barrett’s esophagus cannot be treated by drug therapy. It has been found that even long-term use of drugs that reduce acidity, does not cope with the pronounced symptoms of reflux esophagitis and when canceled causes a relapse of the disease in a short period of time.

Antireflux surgery solves problems associated with the organs of not only the gastrointestinal tract, but also the urinary system, in particular the pathology of the ureters – bladder-ureteral reflux. In this case, there is a backflow of urine from the bladder into the ureter. The cause can be hereditary manifestation, inflammatory process or increased pressure inside the bladder. Both drug therapy and surgery are used to treat this condition.

Antireflux surgery is directly indicated for patients with diagnosed gastroesophageal reflux disease. The surgical intervention can be performed both routinely and urgently in the presence of acute complications that threaten the patient’s life, such as hernia impingement or a growing inflammatory process.

Very often patients seek medical help at a late stage of the disease, when drug therapy ceases to have a proper effect and associated pathologies, such as peptic ulcer disease, esophageal stricture (narrowing), Barrett’s esophagus, gastric bleeding, etc., begin to appear.

The history of abdominal surgery counts many studies of the pathology in search of the best corrective therapy for gastroesophageal reflux disease.

The founder of the successful treatment of reflux esophagitis is Rudolf Nissen. The antireflux operation was first performed by him in 1955 and immediately became the benchmark among other antireflux operations. Subsequently, many alternative methods were developed, and most of them are successfully used in modern surgery today.

Operations aimed at normalizing the lower esophageal sphincter are called “fundoplication”.

Antireflux surgery usually does not cause serious complications due to the fact that it is performed laparoscopically. Due to the peculiarities of the body, there are a few complications that may be encountered by the patient.

Among the postoperative complications are the following:

• dysphagia – swallowing disorder;
  Depending on the applied method of fundoplication, dysphagia may occur for up to 8 weeks. Adjustment of the diet helps to alleviate the condition and shorten this period. If dysphagia persists after 8 weeks after the operation, the patient is examined and, if necessary, a second operation is performed to widen the esophageal lumen or to reconstruct the fundoplication.
• abdominal bloating;
  To alleviate the symptoms, a steady diet with the exclusion of fermentation-promoting foods and supportive drug therapy are used.

• recurrence of GPOD;
  Esophageal hiatal hernia may reappear due to suture divergence after cruorrhaphy. When mesh prostheses are used to restore the correct diameter of the diaphragmatic orifice, the risk of recurrence is minimal.
• persistence of reflux esophagitis symptoms such as heartburn and belching.
  Persistence of symptoms of reflux esophagitis may be indicative of poor dietary intake or of a stretched or torn fundoplication cuff. If a cuff tear is confirmed, reoperation will be required.
• symptoms of dyspepsia and diarrhea.
  In most cases, symptoms of dyspepsia and diarrhea are temporary and can be managed with drug therapy in combination with a special diet.

Minimal invasiveness and a short recovery period are the hallmarks of endoscopic surgery.

In the case of antireflux surgery, the main efforts in the recovery period are aimed at normalizing the work of the gastrointestinal tract.

In addition, from the first hours after the completion of the operation, it is highly desirable to take a number of preventive measures to prevent the formation of blood clots, namely:

• breathing exercises;
• motor activity;
• wearing compression stockings.

Subsequently, at least for several months, you should follow a special dietary regimen, avoid heavy physical exertion and follow the prescriptions of the attending physician for successful rehabilitation and a speedy return to the usual way of life.