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Fundoplication for GERD,Hiatal Hernia


Laparoscopic nissen fundoplication surgical procedure is done to treat gastroesphageal reflux disease (GERD) and hiatal hernia. Acid reflux happens when stomach acid flows backwards into the esophagus causing heartburn and other symptoms. Chronic and severe acid reflux is called gastroesophageal reflux disease (GERD). Sometimes, mild reflux symptoms can be relieved with healthy diet, lifestyle changes and medications such as antacids, H2 blockers etc. Surgery is required when all these methods does not provide any relief from the symptoms.  Surgery is required to repair or replace the bottom valve of the esophagus that keeps acid from refluxing or moving backward from the stomach. This valve is known as lower esophageal sphincter (LES) and a weak or damaged LES causes GERD. In some cases, symptoms may recur and patient may need to take medications or may require another operation.  A hiatus hernia occurs when the opening in the diaphragm which allows the oesophagus to pass from the chest into the abdomen becomes too wide and allows the stomach to slip into the chest. A hiatus hernia may occur without reflux and vice –versa and they are usually treated together through surgery. Some common symptoms of hiatus hernia are heart burn, bitter taste fluid into throat, difficulty in swallowing etc. 

Advantages of fundoplication surgery include:
Less pain
Fewer and smaller incisions or scars
Shorter hospital stay
Faster recovery

Doctor may recommend some tests such as endoscopy, barium X-rays, 24 hr PH monitoring, PH capsule etc to diagnose the gastric reflux problems. Surgery is performed under the influence of general anesthesia. Surgeon will make small keyhole size incisions in the upper abdomen to insert a tube called trocar through which laparoscope (thin, flexible tube with a light and camera at the end) is placed into the abdomen. The images from the camera can be seen on the large monitor for a surgeon to view and allow him to operate more precisely. In this procedure, surgeon wraps the top of the stomach around the lower esophagus and sews it in a place which tightens the esophagus and helps in preventing stomach acid from backing up into it. Laparoscope can also be used to put a ring of titanium beads around the outside of the lower esophagus to strengthen the valve between the esophagus and stomach. The incisions are closed and covered with bandages. 
Hiatus hernia surgery is usually a keyhole surgery which involves around 5 small incisions. Surgeon will wrap the top part of the stomach around the lower portion of the oesophagus to make a new valve and stitch it into place. If the wrap has slipped or is too loose or if the patient is having difficulty in swallowing, then another surgery is required.  This procedure can take 60 to 90 minutes. 
Patient may generally require staying in the hospital for 2-3 days. Pain medication or non steroidal anti-inflammatory drugs may be recommended for few days post surgery. Patient can go back to work or their normal routine in 2 to 3 weeks after the surgery, depending on the nature of the work but should avoid lifting any heavy weights for 8 to 12 weeks. It is recommended to change the diet and food habits and may require eating only soft or liquid foods till the time surgery heals. 
Laparoscopic nissen fundoplication and hiatus hernia repair surgery is generally considered as a safe and effective procedure but may also involve some risks and complications such as:
Infection
Damage to blood vessels
Difficulty in swallowing 
Gas embolism
Scarring
Irritable bowel syndrome
Nausea or vomiting 
Recurring heartburn
Excess gas
Reaction to anesthesia
Recurrent hiatus hernia
Injury to lung
gastroparesis


Patient should inform doctor immediately in case of:
severe pain in abdomen or chest
vomiting and nausea
severe problem in swallowing food

 

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