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Laparoscopic Reflux Surgery

What is Laparoscopic Reflux Surgery?

Laparoscopic reflux surgery, also known as  fundoplication, is a minimally invasive surgical procedure employed for the treatment of gastro-oesophageal reflux disease (GORD) It corrects gastro-oesophageal reflux by creating an effective valve mechanism in the bottom of the oesophagus preventing reflux from the stomach into the oesophagus.

What is Laparoscopy?

Laparoscopy, also known as keyhole surgery, is a minimally invasive surgical technique where a laparoscope - a flexible fibre-optic lighted instrument attached with a camera - is introduced into the abdomen or pelvis through few small keyhole incisions along with tiny specialised instruments to visualise, diagnose, and repair abnormalities of the structures.

Indications for Laparoscopic Reflux Surgery

The indications for laparoscopic reflux surgery are

  • Reflux not controlled with medication and lifestyle measures
  • Reflux with complications not treated by medication eg, Barrett’s, or a stricture
  • Volume reflux: getting fluid in the back of the throat or regurgitation
  • Desire not to take lifelong medication
  • Complications of the medications.

Preparation for Laparoscopic Reflux Surgery

Preparation for surgery will involve the following steps:

  • Your surgeon will thoroughly explain the procedure in detail and take your written consent for surgery.
  • Preoperative workup, such as medical evaluation, blood work will be done.
  • Additional tests may be advised if required depending on your medical history.
  • An anaesthesiologist will meet you to inform the type of anaesthesia that will be used during surgery.
  • You may take a shower the night prior to or the morning of the operation.
  • You should refrain from food or drink the night prior to your surgery.
  • If you are on any medicines, such as blood thinners, or any supplements, they may need to be stopped temporarily prior to surgery.
  • Refrain from smoking

Procedure for Laparoscopic Reflux Surgery

Laparoscopic anti-reflux surgery, commonly referred to as Laparoscopic  Fundoplication, involves reinforcing the “valve” between the oesophagus and the stomach by wrapping the upper portion of the stomach around the lowest portion of the oesophagus.

The procedure usually takes 1 to 2 hours and involves the following steps:

  • General anaesthesia is administered to keep you asleep throughout the procedure.
  • The surgical site (abdomen) is marked and thoroughly cleaned.
  • Few small keyhole incisions are made on the abdomen.
  • A laparoscope is inserted through one of the incisions.
  • Carbon dioxide gas is pumped into the abdomen through a small sterile tube passed into the abdominal cavity for better visualization of the structures through laparoscope.
  • Small miniature instruments are inserted through the other incisions.
  • The laparoscope provides a magnified view of the internal structures on a television screen, and your surgeon stitches the diaphragm to reduce the size of the hole the oesophagus passes through.
  • The top part of the stomach is wrapped around the lower portion of the oesophagus and stitched. This reinforces the lower oesophageal sphincter so that food does not reflux back into the oesophagus.
  • Finally, your surgeon will check for any bleeding, rinse out the abdominal cavity, and close the small keyhole incisions.

Postoperative Care and Instructions

Post-procedure care and instructions will include the following steps:

  • You will be transferred to the recovery area where you will be asleep until the anaesthesia wears off.
  • It is normal for you to feel soreness in the throat due to the breathing tube used during surgery and pain in the abdominal area once you gain consciousness.
  • You may experience bloating, cramping, and pain in the shoulder due to the carbon dioxide gas that was used during surgery.
  • You will be given pain medicines and anti-nausea medications to relieve your discomfort.
  • Your nurse will monitor your blood oxygen level and other vital signs as you recover in the recovery area.
  • Instructions on surgical site care, diet, and bathing will be provided.
  • You can return to your normal activities, such as showering, driving, and walking within a short period of time.
  • Complete recovery usually takes about 4 weeks, and you should gradually increase your activity level with light activities.
  • Refrain from strenuous activities and do not lift anything heavier than 10 kg
  • Strictly adhere to follow-up appointments to monitor your progress.

Benefits of Laparoscopic Reflux Surgery

Some of the benefits of laparoscopic reflux surgery include:

  • Small surgical cuts
  • Minimal pain and bleeding
  • Shorter hospital stay
  • Faster recovery time
  • Reduced scarring
  • Reduced risk of infection
  • Minimal damage to surrounding tissues
  • Improved cosmetic result

Risks and Complications of Laparoscopic Reflux Surgery

Laparoscopic reflux surgery is a relatively safe procedure; however, as with any surgery, there may be some minimal risks, such as:

  • Bleeding
  • Infection
  • Blood clots
  • Damage to nearby organs
  • Anaesthetic complications

What If I Experience Any Problems During Recovery?

You should call your doctor and seek immediate medical care if you experience:

  • Bleeding
  • Increased abdominal swelling
  • Chills or fever over 38 degrees
  • Pain that does not get better with pain medicines
  • Nausea or vomiting
  • Cough or shortness of breath
  • Pus from incision sites
  • Swelling or redness in the incision sites
  • Difficulty in swallowing food or liquids

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