Gastroesophageal reflux disease (GERD) describes the condition where contents of the stomach, including stomach acid, leak back into the esophagus, irritating and even damaging the lining of the esophagus. Food and liquids are carried along the esophagus from the mouth to the stomach. The lower esophageal sphincter muscle, situated at the end of the esophagus, normally closes off the stomach. Gastroesophageal reflux happens when this muscle does not close well allowing stomach contents to re-enter the esophagus.
Symptoms of GERD include heartburn or a burning sensation in the chest, a feeling that food is stuck, nausea after eating, difficulty swallowing and hiccups. Experiencing these symptoms several times in a week can indicate you may have GERD. Causes include hiatal hernia, obesity, and conditions that cause an excess of stomach acid.
A laparoscopic Fundoplication is a minimally invasive approach that involves specialized video equipment and instruments that allow a surgeon to perform the procedure through four tiny incisions, most of which are less than a half-centimetre in size. One advantage of this method is a brief hospitalization. Most of the time it will require an overnight stay. Other advantages include less pain (less of a need for pain medication), fewer and smaller scars, and a shorter recovery time.
Laparoscopic Fundoplication is a safe and effective treatment of GORD. However, in rare cases the laparoscopic approach is not possible because it becomes difficult to visualize or handle organs effectively. In such instances, the traditional incision may need to be made to safely complete the operation.
A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Although hiatal hernias are present in approximately 15% of the population, they are associated with symptoms in only a minority of those afflicted.
Normally, the esophagus or food tube passes down through the chest, crosses the diaphragm, and enters the abdomen through a hole in the diaphragm called the esophageal hiatus. Just below the diaphragm, the esophagus joins the stomach. In individuals with hiatal hernias, the opening of the esophageal hiatus (hiatal opening) is larger than normal, and a portion of the upper stomach slips up or passes (herniates) through the hiatus and into the chest. Although hiatal hernias are occasionally seen in infants where they probably have been present from birth, most hiatal hernias in adults are believed to have developed over many years.
Types of Hiatal Hernia :-
Sliding Hiatal Hernia The most common (95%) is the sliding hiatus hernia, where the gastro-esophageal junction moves above the diaphragm together with some of the stomach.
Rolling Hiatal Hernia The second kind is rolling (or paraesophageal) hiatus hernia, when a part of the stomach herniates through the esophageal hiatus and lies beside the esophagus, without movement of the gastro-esophageal junction. It accounts for the remaining 5% of hiatus hernias.
The procedure is often done 'laparoscopically' through five small (1.5 cm) cuts (incisions) in your abdomen. The video camera and special instruments are then inserted through the incisions to do the repair. You may undergo a "Nissen" Hiatal Hernia procedure where the stomach is wrapped around the lower end of the esophagus to tighten up the sphincter.
Occasionally, the surgeon is unable to do the procedure laparoscopically and must convert to open surgery in order to make it safer for you. In this case, you will have an incision in the middle of your abdomen and your recovery will be longer. To help prevent blood clots from forming in your legs during and after surgery, sequential compression stockings may be applied.
Note: Treatment Options/Results may vary from patient to patient depending on their medical condition.