Standard Laparoscopic Surgery
For the past 20 years, surgery for the treatment of reflux has largely been performed by laparoscopic repair of hiatus hernia. Hospital stay is between one and two days and our complication rate is exceptionally low. There are now more than 3000 patients on our database who have had this surgery.
Revision surgery has been performed on patients who have had operations predominately elsewhere requiring correction. This can be performed by keyhole surgery (laparoscopy), but is dependant on difficulty; standard open surgery may be necessary.
Who is suitable for surgery?
|Patients with continued symptoms despite medication||These include:
|Patients with very large Hiatus Hernia||These hernias can be life threatening and cause severe symptoms frequently, especially being short of breath.|
|Patients with abnormalities in Barrett’s Oesophagus||In combination with other management, surgery may be helpful in reducing cancer risk.|
|Patients concerned with side effects or long term problems of medication.||These can include a decrease in bone density and osteoporosis.|
Most patients are out of hospital in 1 ½ days and require very little pain relief. It is often reasonable to drive at one week and work thereafter at a sedentary job.
We perform fundoplication similar to the Nissen but designed to be to be robust enough to last and loose enough to minimise side effects. Much has been made of side effects, but we have found them to be infrequent after 6 weeks and not greatly troubling. They are, however, unpredictable. These consist of reduced belch, variable ability to vomit, sensation of food sticking in the valve, intermittent bloated sensation and increased flatus. In our most recent published report 95% were pleased to have chosen surgery even after 5 years duration.
For reflux surgery to be successful, it must be the key focus of the surgeon. High volume practice leads to effective surgery in the right patients (by testing), and limited digestive side effects. This group focuses on disease of the stomach and oesophagus almost exclusively, leading to better results.
For more information see: http://en.wikipedia.org/wiki/Fundoplication
Watch Professor Falk perform a laparoscopic fundoplication: