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| Reflux surgery
Gastro-esophageal reflux disease, known as GERD, is common. Indeed, the junction between the esophagus and the stomach or cardia is kept under the diaphragm. This acts as an anti-reflux valve, preventing the food and stomach acid from rising up towards the esophagus. However, in the case where the diaphragm edges relax, there is a migration of the gastro-esophageal junction, or even a part of the stomach inside the thorax. We speak then of hiatus hernia. This results in a loss of the valve continence which is characterized by an acid secretion reflux of the stomach into the esophagus: It is the gastro-oesophageal reflux. In the long term, the esophagus is not armed to resist gastric acidity, this leads to inflammation of the lower esophagus and is manifested by a burning sensation behind the sternum, called pyrosis, especially aggravated by leaning forward position. Moreover, there are regurgitations (bitter and acid rising), a nocturnal cough following an irritation of the bronchi by the acid reflux in lying position. Many people with GERD do not consult or treat themselves with medications, probably because their symptoms are mild or intermittent. But nowadays, new techniques make it possible to diagnose any type of GERD and to put in place the appropriate treatments. In fact, gastroesophageal reflux surgery involves placing a valve between the esophagus and the stomach to block upstream food.
Leanr more about the other gastric surgery:
Reflux surgery price
The price of a Reflux surgery in Tunisia coupled with a week of recovery or vacation in a 5 stars hotel is at least % cheaper than the sole procedure in Europe and for the same medical quality.
Preoperative Reflux Surgery
Preoperative preparation includes blood tests, medical examination, a chest x-ray and an electrocardiogram, depending on the patient's age and health status.
Moreover, the endoscopy, demonstrating the oesophagitis presence, alone allows the diagnosis of GERD in a patient with typical symptoms. PH-metry is essential in case of diagnostic doubt. Besides, the manometry enables to point out possible contraindications or to prevent certain postoperative complications. A weak lower sphincter of the esophagus is a good indication for surgery. Whereas, with a very tonic sphincter, it is important to be cautious because of a significant risk of food blockage (dysphagia) after the procedure.
How is Reflux surgery performed?
The main purpose of anti-reflux surgery is to strengthen the hiatus barrier. The standard technique is fundoplication, which consists of closing of the upper part of the stomach called the fundic region. Indeed, it can be complete known as Nissen technique, or partial called Toupet where the tightening of the region is less intense. The procedure is performed under general anesthesia. It last about1 hour.
The procedure is usually performed by laparoscopy using 5 orifices of 5 to 10 mm. In rare cases, it is sometimes necessary during surgery to open and go to laparotomy if there is a dissection difficulty or exceptional complication.
The surgeon puts trocars in place to isolate the hiatal opening between the chest and the abdomen: it is the entire lower part of the esophagus and the upper part of the stomach. Indeed, the NISSEN technique consists in closing the hiatal orifice by one or more points. In some cases, if a large part of the stomach has passed into the thorax, it is sometimes useful to strengthen the suture with a small special prosthesis. Then the upper part of the stomach is passed behind the esophagus and fixed forward with another part of it, realizing a gastric tissue ring around the esophagus reconstituting a valve. The valves are also attached to the esophagus.
The TOUPET technique is identical to the first one; however, the two valves are not interconnected in front, the ring is incomplete.
Post-operative effects and recovery after Anti Reflux surgery
They are usually simple in general, although the intervention can be performed on an outpatient basis, but most often a hospitalization of 24 to 48 hours is enough, mainly because of resumption of food modalities. Indeed, it is immediate, but the patient should take liquid food. Then, they can resume their normal meals but with small quantities to avoid any food blockage risk. It is important to chew well because the intervention creates a certain funnel. Depending on the case, a prescription of antibiotics or prophylactic treatment of phlebitis is necessary.
As for showers, they are possible from the first day with or without dressing with clean water.
Result and outcome after Reflux intervention
Reflux surgery is an effective and long-lasting treatment for gastroesophageal reflux disease. It has higher results in terms of life quality improvement. The Reflux surgery corrects hiatal hernia and reduces inflammation in the mucosa and increases lower oesophageal sphincter pressure and length. During a hiatus hernia cure, the acid cannot go back up into the esophagus. The symptoms related to reflux disappear. Nevertheless, if they were not related to the reflux, they will persist. Hence the preoperative examinations and analysis are essential to better understand the patient case and choose the appropriate technique.