1394 sokak No: 11 Sağlık Merkezi Apartmanı. Kat: 4 Daire: 10 Alsancak - İzmir
It is natural for a patient faced with surgery to have many questions about which he is curious about the answers, let alone his fears about surgery. Of course, in such a situation, he will get the most satisfactory answers from his own physician. In this article, you will find answers to some of the frequently asked questions of patients who meet and question surgical treatment options for reflux disease.
These;
How is it done?
After many unsuccessful attempts, effective surgical methods for reflux disease emerged in the second half of the 20th century. Although different surgical techniques are defined from different centers, basically all of them have similar common features. One of these, "Nissen fundoplication", which is the most preferred by surgeons, was made popular in 1956 by the surgeon Rudolph Nissen. In this technique, after the upper part of the stomach is passed behind the esophagus (esophagus), it is wrapped around the lower end of the esophagus. Thus, thanks to the stomach surrounding the lower part of the esophagus like a tie, the pressure in this area is increased and it is aimed to prevent reflux (See Picture). A frequently asked question at this point; Whether procedures such as "cutting-piece removal" are performed in the stomach or esophagus. The answer is "no". In other words, there is no cutting or removal of parts in the stomach and esophagus.
In the last quarter of the century, the number of patients undergoing surgical treatment has decreased considerably thanks to the drugs found (proton pump inhibitors, H2-receptor blockers, etc.). This decrease was not due to failure in surgical treatment, but because many patients became treatable with medication.
In 1991, after the "Nissen fundoplication" performed by the Belgian surgeon Dallemagne using the laparoscopic method, surgical treatment was brought up again and was questioned. As this process progressed, the success results achieved in Europe and America encouraged both patients and physicians dealing with this disease, and as a result, the number of anti-reflux surgeries gradually increased. Today, more than 5000 laparoscopic anti-reflux surgeries are performed annually in the United States alone.
I think it would be appropriate to give some information on this subject, considering that there may be some of our readers who have never heard or heard of laparoscopic surgery technique, even if they have incomplete and incorrect information.
Laparoscopic surgery represents one of the areas where developing technology is mostly used. During this procedure, the patient's abdominal cavity is inflated with CO2 gas at a certain pressure and a 1 cm incision is made on the navel and a special camera system displays the abdominal cavity. Then, three or four more incisions, each 0.5-1 cm, are made, allowing the use of other surgical instruments and the operation is performed. Of course, this operation is performed under general anesthesia conditions.
Advantages
The procedure for reflux is the same in surgeries performed with either laparoscopic (closed technique) or open technique in which the whole abdomen is opened. However, there are great differences between the two methods in terms of the comfort of life of the patient in the postoperative period. In laparoscopic surgery, the patient's pain due to surgery is less than the open technique. What I want to emphasize here about the pain is that it is both less severe and shorter in duration. On the other hand, the time required for patients to return to their normal lives, in other words to continue their daily activities as before, is much shorter in laparoscopic surgery. In addition, postoperative wound hernia and infection are almost non-existent in laparoscopic surgery.
Can laparoscopic anti-reflux surgery be applied to all patients?
It is not completely impossible for patients who have previously undergone surgical intervention in the upper abdomen with an open technique to be treated with laparoscopic method. However, it is an undeniable fact that these chances have decreased a little. In addition, in some patients, personal anatomical incompatibilities or existing concomitant diseases can make laparoscopic surgical intervention difficult. On the other hand, another fact that should be known is that the cost of laparoscopic surgery performed with most imported materials is higher in our country's conditions.
What is the duration of the surgical intervention?
The duration of the operation has always been a curious issue and has even been equated with the difficulty level of the surgery. What should be said here is that the duration of anti-reflux surgeries performed with open and closed techniques is almost equal. This period may vary depending on the characteristics of the patient, as well as an average of 45-90 minutes.
Results
Patients with reflux complaints who have been offered surgery and even their physicians are most concerned about the outcome of the surgery. It is not always possible to give an exact answer to this question. Because not all of the factors that are effective in obtaining a satisfactory response to surgical treatment are fully understood yet. In general, the success rate of surgical treatment in the world is over 90%. In other words, while 90 out of 100 patients who underwent surgery are satisfied with the result, some problems may be experienced in the remaining group. In this low rate group, reflux complaints may continue in a small number of patients, and some new complaints may arise although reflux complaints disappear in some. These complaints generally focus on the feeling of being stuck at the lower end of the esophagus or the accumulation of gas in the stomach while swallowing. When these complaints, which can be considered normal in the early postoperative period, are permanent, of course, they cause discontent. However, this problem is not unsolved. Permanent swallowing difficulties can be resolved by an experienced gastroenterologist by expanding the passage with a balloon during endoscopy.
Prof. Dr. Sinan Ersin
Ege University Faculty of Medicine
Department of General Surgery
