Two operations are principally used to prevent the reflux of stomach juices into the oesophagus. On the one side, reflux surgery, on the other side hiatal hernia surgery. If the patient has a weakness of the oesophageal sphincter, this will be undertake first. Diaphragmatic surgery is required in the event of a hiatal hernia.
The reflux operation is a surgical treatment option if stomach juices flow into the oesophagus. This disease is called gastroesophageal reflux or GERD for short. The consequences are inflammation in the oesophagus and heartburn. The reflux of stomach juices into the oesophagus can have various causes. The oesophageal sphincter is often weakened. Surgery is usually only performed if the medical treatment has been ineffective. If there is a weakness in the oesophageal sphincter, this is known as fundoplicatio.
A hiatal hernia is another relatively common cause of reflux. If there is a hiatal hernia, the diameter of the oesophagus is widened through the diaphragm. A part of the stomach can slip into the chest through these gaps. As a result, this promotes reflux of the stomach juices into the oesophagus. In this case, hiatal hernia surgery can be helpful.
What preparations are carried out before the procedure?
The diagnosis of reflux or hiatal hernia is normally made with a gastroscopy and a contrast agent x-ray.
All the usual pre-operative assessments are required, such as a blood test, blood pressure measurement and an ECG. All blood-thinning medication must be discontinued before the procedure takes place. Reflux or diaphragmatic surgery is performed under general anaesthetic. Patients should therefore have an empty stomach for the procedure.
How is the operation performed?
If the patient just has a weakness in the oesophageal sphincter, reflux surgery (Nissen fundioplication) is undertaken. If he or she has a hiatal hernia, hiatal hernia surgery is preferred. If there is a simultaneous weakness of the sphincter, diaphragmatic surgery is sometimes combined with Nissen fundoplication. Nowadays both operations are usually carried out laporoscopically. This minimally invasive procedure involves inserting a video camera and surgical instruments into the abdominal cavity via small incisions.
Reflux surgery, Nissen fundoplication
The goal of Nissen fundoplication surgery is to strengthen the oesophageal sphincter. A sleeve is formed from the upper part of the stomach and then laid around the oesophagus. As a result, the muscle pressure on the mouth of the oesophagus increases when the stomach fills up. Five incisions are required in the upper abdomen for the procedure to insert the instruments and the camera. Air is fed into the abdominal cavity to create more room and to provide a better overview. This is released again after the surgery, and the operation wounds are sutured.
Hiatus hernia surgery
Hiatus hernia surgery is also performed with the minimally invasive keyhole technique. Firstly, all the parts of the stomach which have pushed through the hiatus hernia are pushed back. Then the enlarged gap in the diaphragm is reduced with a stitch or reduced in size by attaching a biological net (hiatoplasty). Sometimes the stomach is also surgically attached to the diaphragm (fundopexy).
If there is also a weakness of the oesophageal sphincter, the hiatus hernia surgery is combined with Nissen fundioplication.
What is the success rate of this procedure?
If a hiatus hernia is responsible for the reflux, the disease is usually cured with the surgery. If the sphincter is weakened, the patient may suffer relapses after surgery.
What are the possible complications and risks of this procedure?
As with all surgery, the operation may occasionally lead to infections, nerve damage, and post-operative haemorrhaging. In rare cases, it can cause injury to the abdomen, the oesophagus or the pleura.
What happens after the operation?
After the operation, the patient's food intake is carefully increased, beginning with liquid and then pureed food. From about the third day onwards, he or she can eat normally once more. Patients who undergo this operation must generally stay in hospital for two to three days. Before they are discharged, a contrast agent x-ray of the oesophagus and the stomach will be performed to check the success of the operation.
People who have undergone this surgery should avoid major physical exertion in the first six weeks after the operation. Factors which promote reflux of stomach juices into the oesophagus should be avoided. For example, smoking, excessive alcohol consumption and rich food.