By: Jean Johnson for Reflux1Grandpa might have called it heartburn and managed with nothing more than Rolaids and sitting up in his chair after one of grandma’s meat and potatoes dinners. These days, though, gastroesophageal reflux disease (GERD), or acid reflux, can be treated with a range of physician-prescribed drugs or various procedures including endoscopic or laparoscopic (minimally-invasive surgery).
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Fast facts about GERD:
Acid reflux is common and experienced by nearly one in every three people.
GERD is aggravated by heavy meals, nicotine, fatty foods, obesity and lying flat in bed. Symptoms are reduced by making lifestyle changes that avoid these behaviors.
Prolonged and frequent acid in the lower esophagus can cause injury such as inflammation, ulceration, scar formation, and stricture and, after a long period of time, even cancer.
General measures such as acid-reducing medicines, antacids, and diet modification can control most cases.
Many GERD patients help minimize distress by eating small frequent meals.
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That’s a good thing, since some of the symptoms – shortness of breath and tightness in the chest – can sometimes make a person feel like they’re having a heart attack. And at the very least patients with GERD generally experience a harsh burning sensation in their chest area where the esophagus connects the mouth to the stomach.
Recent study says acid reflux lap surgery effective over long haul
A recent study reported in the October 2005 issue of Archives of Surgery on treating GERD with laparoscopy (lap) surgery is encouraging. French researchers followed 1,340 people from 31 hospitals for approximately seven years. They found that not only did the procedure curtail symptoms initially, but also that patients experienced sustained relief over the longer term.
“In this study, the intraoperative and postoperative complication rates were 2.1 percent and 2.6 percent respectively, with a subsequent operation rate of 4.4 percent at five years,” lead researcher, Patrick Pessaux, M.D., and his colleagues reported.
“Of interest, overall patient satisfaction following surgery was high with 93.1 percent of patients satisfied with their long-term outcome and 94.1 percent willing to have the surgery again. Although nearly 10 percent of patients resumed taking anti-secretory medication, in most, no evidence of reflux recurrence could be found.”
While a small number of studies have examined long-term effectiveness, they have not followed patients longer than five years. Still, the Pessaux study did not break new ground, but instead confirmed what practitioners in the field already believed.
“In conclusion, the results of this study do not differ significantly from the data reported in the literature, suggesting that laparoscopic anti-reflux surgery is an effective long-term procedure, is well tolerated, and can be properly used in the treatment of GERD,” Pessaux and the other authors of the study wrote.
The magic of laparoscopy
Many women have heard of laparoscopy, also known as bellybutton or Band-Aid surgery, since beginning in the 1970s gynecologists have widely used the technique to tie the fallopian tubes among other procedures related to the female organs.
That said, even those still in the dark on the subject of lap surgery can appreciate the technique if they think in terms of an almost magical way of repairing internal bodily problems occurring in the abdominal cavity from outside the body.
Indeed, via tiny cameras with exquisite magnification and ultra thin instruments or robotic arms capable of cutting and sewing, lap surgeons are able to get inside to work without a full scale invasion requiring a major incision.
This cutting-edge technology has been revolutionizing medicine in a number of specialties from gynecology to urology to liver and gallbladder surgery among a host of others for some time now, and particularly over the last 40 years has increasingly become the option of choice for patients that are suitable candidates.
Laparoscopic Fundoplication
The upper part of the stomach is called the fundus and fundoplication is what lap surgeons do to restore function to the lower esophageal sphincter, a device that keeps acid in the stomach instead of allowing it to travel back up the esophagus. Once the patient is under general anesthesia, according to Jackson Gastroenterology in Camp Hill, Pennsylvania, “the abdomen is inflated with carbon dioxide, a harmless gas, through a small incision at the naval. Then, the laparoscope, a thin tube carrying the video camera is inserted, and four pinpoint incisions are made in the upper abdomen through which needle-like instruments are inserted. These act as the hands of the surgeon, allowing him or her to dissect and suture. The upper part of the stomach is then wrapped and sutured around both sides of the esophagus. This technique restores normal pressure to the lower esophageal sphincter and prevents acid from refluxing into the esophagus.
Laparoscopic surgery is minimally invasive and in the case of reflux procedures, the five very small incisions endoscopic surgeons make in the abdomen to insert instruments and a camera necessary for the procedure heal with only slight blemishing. In the immediate aftermath of lap surgery pain is minimal usually requiring no medication after one to two days. Patients are usually started on clear liquids the first day after surgery and discharged from the hospital later that same day. Soft diets are recommended for one to two weeks and typically patients return to normal activities within one week.
