Gastro-oesophagial Reflux Disease (GORD)
Typical Symptoms: heartburn, regurgitation, dysphagia/odynophagia, water brash
Some patients with GORD may not have apparent symptoms, and the presence of GORD is revealed when complications such as sticture or Barrett's oesophagus become evident.
Management of GORD
Lifestyle modifications
Surgery
Surgical treatment for gastro-oesophageal reflux disease is extremely effective in controlling reflux and nowadays is undertaken by keyhole technique in more than 90% of cases
Indication for Surgical Treatment of GORD
The indications for patients referral for surgery are as follows:
- Patients who do not respond to medical treatment.
- Patients requiring increasing doses of PPI.
- Young patients with long-term need for aggressive medical therapy.
- Patients who do not wish to undergo long-term medical therapy because of the inconvenience or fear of side effects.
- Patients who have severe erosive disease and are likely to require long-term high dose treatment.
- Patients with large hiatus hernia.
- Patients who develop severe complications of GORD, despite medical therapy, like oesophageal stricture, ulceration, Barrett’s oesophagus.
- Patients with progressively worsening extra-oesophageal symptoms, despite regular use of PPI.
It is important that patients with severe gastro-oesophageal reflux disease should be offered a choice of surgery to get relief of their symptoms. Nowadays this surgery can be undertaken laparoscopically with minimal morbidity and very good 5 and 10 year results.
The standard surgical treatment for GORD is Laparoscopic fundoplication. This is an extremely effective operation and cures the problem of reflux instantly. The operation is done by keyhole technique. Patients go home in one or two days. At the time of discharge patients eat a soft and sloppy diet and it takes few weeks to return to normal eating. The main side effects of the operation are difficulty of swallowing certain foods like bread and meat, and abdominal bloating. These settle within a few months in the majority of patients and only 5% of patients may have long term problems of varying severity.
Personal Experience
I have been doing keyhole antireflux surgery for more then 10 years have performed hundreds of these procedures with extremely good results. I have presented my works in national and international medical meetings.
When is surgery necessary?
People with severe, chronic oesophageal reflux might need surgery to correct the problem if their symptoms are not relieved through other medical treatments. If left untreated, chronic gastro-oesophageal reflux can cause complications such as oesophagitis, oesophageal ulcers, bleeding, or scarring of the oesophagus.
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Laparoscopic anti-reflux surgery (also called Nissen fundoplication) is used in the treatment of GORD when medicines are not successful. Laparoscopic anti-reflux surgery is a minimally-invasive procedure that corrects gastro-oesophageal reflux by reducing the hiatal hernia, reconstructing the oesophageal hiatus and reinforcing the lower oesophageal sphincter. Positions of small incisions (5-10mm) for laparoscopic anti-reflux surgery |
Who can have this surgery?
Anyone who is suffering from severe reflux disease which is not controlled by medical treatment or who is unable to take medication regularly can have this surgery.