Surgery
for reflux
Heartburn is a very common condition. It
is due to reflux of acid from the stomach into the
oesophagus (gullet). It may be possible to deal with
symptoms of reflux by adopting lifestyle changes and / or
using medication. However these measures are not always
effective and a significant percentage of people may
require surgery to control symptoms. In addition many,
particularly younger, people are unhappy to stay on
medication long-term or for life. General practitioners may
be reluctant to prescribe the best medication because of
cost. There is now a very effective keyhole operation for
such patients called a laparoscopic fundoplication. This is
an operation designed to prevent acid refluxing into the
oesophagus. Many patients with reflux have a hiatus hernia
and the operation will deal with this at the same time.
Reflux of acid irritates and eventually causes damage to
the oesophagus. The main symptom is heartburn. This often
occurs after a heavy meal or when lying flat at night. The
pain of heartburn is felt in the chest but may also be felt
in the back or neck. If untreated reflux can result in
permanent damage to the oesophagus. The gullet may become
narrowed (a stricture) resulting in difficulty with
swallowing. Also a change in the lining layer of the
oesophagus (known as Barrett's change) may result from
prolonged reflux and can result in the growth of a cancer.
The first investigation for reflux symptoms is usually an
endoscopy. This is where the doctor passes a camera on the
end of a long flexible tube into the gullet. If there is
any damage to the oesophagus it can be easily seen and a
biopsy may be taken to assess the damage. More
sophisticated tests may be needed, particularly where
surgery is being considered.
Treatment in the first instance consists of simple
lifestyle changes including weight loss, avoidance of
stooping, raising the head of the bed and avoiding large
late night meals. Most patients however require some form
of medication, either from time to time or regularly. These
range from simple antacids for mild cases to a group of
drugs called proton pump inhibitors.
If medical treatment fails or symptoms return rapidly after
stopping medical treatment then it is worth considering a
surgical solution. Reflux is primarily a mechanical problem
and whilst tablets can control symptoms they do nothing to
the underlying cause which is a deficiency in a valve
mechanism at the lower end of the oesophagus. The only way
to correct this mechanical problem is by an operation, the
most common of which is a laparoscopic fundoplication. The
operation is highly effective and should also be considered
for patients who require lifelong treatment or who do not
wish to remain on medication long-term. Another group of
patients for whom surgery should be considered are those
who have developed complications of reflux such as
stricture or Barrett's change.
This is an advanced keyhole operation and it is important
that you ensure that your surgeon is skilled in this
technique.
For more
information please visit our 'Patient Information' page where
you can download information sheets relating to the
specific operations.