Surgery for GERD

Surgery for GERD

Gastroesophageal Reflux Disease (GERD) is a common chronic disease that occurs worldwide. It is a condition which affects mostly the urban population. Heartburn is a common symptom for GERD. Patients suffering from gastroesophageal reflux disease will experience a burning sensation in the upper abdomen causing discomfort. The other associated symptoms of GERD are dysphagia and fluid regurgitation. Atypical symptoms are sore throat, wheezing, hoarseness, coughing and asthma.

Lower Oesophageal Sphincter malfunction leads to GERD. The LES muscle acts as a valve encompassing itself at the junction of the stomach and the oesophagus. When food is swallowed, it passes through the oesophagus into the stomach during which process, the valve opens. It then closes to prevent the contents from the stomach to reflux back into the oesophagus. Dysfunction of the sphincter leads to back-flow of gastric contents resulting in GERD. Laparoscopic antireflux procedure or laparoscopic Nissen fundoplication is conducted to manage GERD.

 

Surgical indications

Indications for the surgery include complications of GERD such as Barrett’s oesophagus, extraesophageal manifestations like aspiration and asthma and recurrent complications of a previous antireflux procedure. A thorough preoperative evaluation of the patient’s medical history and physical examination are done. Several tests are conducted to ensure evidence of GERD.

 

How is it performed?

  • Before the start of the surgery, general anaesthesia is administered.
  • The surgeon makes a small incision above the belly button, through which the laparoscope, which is connected to a video camera, is inserted.
  • Four to five additional small incisions are made. Instruments called trocars and cannulas are inserted through the small incisions. These incisions give the surgeon access to the abdominal cavity.
  • To correct GERD, the surgeon wraps the upper part of the stomach (called the fundus) around the lower portion of the oesophagus. This reinforces the lower oesophageal sphincter so that food will not reflux back into the oesophagus.
  • Once the surgery is complete, the incisions are closed and the area is dressed.

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