Gastro-esophageal reflux surgery

Definition

Définition RGO

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When one suffers from backward flow gastro œsophagien, the acid contained in the stomach ebbs or goes up stomach towards the oesophagus. That causes its irritation and ignition (oesophagite)

Symptoms RGO  

  • The backward flow is described an intense feeling of burn: This feeling is felt between the coasts or right in bottom of the neck with a possible irradiation in all the chest, the throat and the neck

  • Difficulty in swallowing

  • ◊ chronic Cough  

  • ◊ whistling Breathing

 

 

 

Causes

Causes of RGO

 

When you eat, food passes from the mouth to the stomach in a tube called the oesophagus. The lower part of the oesophagus is made of a muscle in the shape of ring which is called “sphincter lower oesophagus” (SIO) which functions a little like a valve with one way.

In normal weather, the SIO is immediately closed after the ingurgitation of food in order to prevent that the liquids contained in the stomach (of which the rate of acidity is high) do not go up in the oesophagus.

The RGO occurs when the SIO does not do its work and lets ebb the acid liquids of the stomach which burn the lower part of the oesophagus then.

It results an irritation and an ignition from it from the oesophagus, which causes the brûlements of stomach and can possibly damage the oesophagus.

  • Factors likely to cause the relaxation of the SIO

     

  •  Certain types of drugs
     Too tight clothing
    Tobacco addiction
    Alcohol consumption
    Intense exercises
    Changes of posture (to lean forwards or to lie down on the back

  • Hiatal hernia = A large number of patients who suffer from RGO can present a hiatal hernia which does not cause necessarily sympthomes of oesophagite

 

Signes and Symptoms

Signs and Symptoms of RGO

  • Feeling of burn in the chest which increases when one leans ahead.

    ◊ Pain while swallowing

    ◊ night Cough due to an irritation of the bronchi by the acid backward flow when one is lengthened

    ◊ Irritation attends throat bringing to consult a ORL                                Anaemia feeling of weakness and paleness due to a bleeding caused by the hiatal hernia.

 

Treatment

Treatment RGO

The treatment usually proceeds in three successive stages:

1.  Change of the lifestyle

? For a large number of people, to change her food and to take antiacids can reduce the frequency and the intensity of the symptoms.  To lose weight, to reduce its consumption of cigarettes and alcohol, or to stop consuming these products, and to modify its type of food and sleep can also help to fight the RGO.

2.  Catch of drugs

When the symptoms persist, of the drugs can be necessary.  The antiacids neutralize the acid contained in the stomach, and over-the-counter drugs reduce the quantity of acid produced. Although the two types of drugs can relieve the symptoms, those which require a regulation can be more effective to cure the irritation of the oesophagus and to relieve the symptoms.  The medicamentous therapy must be discussed with your surgeon.

3. Surgery

With what to expect you if you choose to undergo a surgery anti-backward flow by laparoscopy
The people for whom to change lifestyle or to take médicamenrts does not give good performances or those which constantly need drugs to stop their symptoms, must be accustomed to live with their problem or to undergo a surgery.

The surgery proves to be a very effective treatment in the event of RGO among patients who are good responders with the treatment medical by inhibitors of the protonic pump

Discuss with your surgeon and your doctor in order to determine if you are a candidate with one or the other of these interventions.

Laparoscopy

 

Care with LAPAROSCOPY

RGO and hiatal Hernia

 

 

RGO and hiatal Hernia

 

The advantages of the laparoscopy are generally the following:

Fundoplicature with 360° according to Nissen (laparoscopic floppy Nissen)

  • BENEFITS

  • Less postoperative pain

  • Duration of the stay to the shorter private clinic

  • Return to faster work

  • Better aesthetic results

 

VIDEO ANIMATION REFLUX SURGERY

 

Indication with the cure of the backward flow by laparoscopy

Although there are several advantages with the surgery anti-backward flow by laparoscopy, this intervention is perhaps not adapted for all the patients.

Indications               

  • Patients with important régurgitations
  • persistent under IP with disappearance of the pyrosis                                                                      
  • Patients with typical symptoms of backward flow
  • age lower than 50 years

  • complete failure with anti-secretary treatment

 

A medical evaluation supplements by a surgeon specialized in surgery anti-backward flow by laparoscopy (after consultation with your family doctor

and your gastro-enterologist, is necessary to determine if the intervention is the best choice for you.

After having discussed the possible risks and benefit the operation with your surgeon, you will have to supplement a form of assent.

Results of surgery

Results of Reflux surgery

Results of the Surgery of reflux

 

Immediate results on symptoms = excellent in 90% of the cases

Conversion rate < 2%
Mortality nonworthless but lower than 0.8%
Morbidity | 5%
 

Side-effects after surgery of the backward flow

That is to say appearance of new symptoms =

  • Dysphagie 5% de re interventions (9.6% after Nissen, 1.6% after Cheeck)

  • Gas-bloat syndrome

  • Early satiety

  • Diarrhoea  

That is to say aggravation of preexistent symptoms =

 

  • Aerophagia

  • Distensions

  • Slownesses