Fundoplication for GERD, Hiatal Hernia

What is Gastroesophageal Reflux Disease (GERD)

The term gastroesophageal reflux describes the movement (or reflux) of stomach contents back up into the esophagus, the muscular tube that extends from the neck to the abdomen and connects the back of the throat to the stomach. Because the stomach manufactures acid as an aid to digestion, this phenomenon is often referred to as acid reflux. Most people experience acid reflux from time to time as heartburn, a burning sensation below the breast bone that occurs after eating or at night. When the frequency of acid reflux is much greater than normal, or complications develop as a result of acid reflux, the condition is known as gastroesophageal reflux disease, or GERD.

What Causes GERD

There are many theories as to the underlying cause for GERD. Most center around the function of the valve-like tissue which is located at the junction of the esophagus and stomach and is supposed to prevent stomach contents from refluxing into the esophagus. People with GERD usually have an abnormal function of this valve. The valve may have a pressure that is lower than normal, it may open at inappropriate times, or it may be displaced into the chest (a condition known as hiatal hernia) resulting in abnormal function. Stomach contents, including stomach acid, bile salts, and pancreatic digestive juices, can cause severe irritation when they come into contact with the lining of the esophagus.

There are many theories as to the underlying cause for GERD. Most center around the function of the valve-like tissue which is located at the junction of the esophagus and stomach and is supposed to prevent stomach contents from refluxing into the esophagus. People with GERD usually have an abnormal function of this valve. The valve may have a pressure that is lower than normal, it may open at inappropriate times, or it may be displaced into the chest (a condition known as hiatal hernia) resulting in abnormal function. Stomach contents, including stomach acid, bile salts, and pancreatic digestive juices, can cause severe irritation when they come into contact with the lining of the esophagus.

A laparoscopic Fundoplication is a minimally invasive approach that involves specialized video equipment and instruments that allow a surgeon to perform the procedure through four tiny incisions, most of which are less than a half-centimetre in size. One advantage of this method is a brief hospitalization. Most of the time it will require an overnight stay. Other advantages include less pain (less of a need for pain medication), fewer and smaller scars, and a shorter recovery time.

Laparoscopic Fundoplication is a safe and effective treatment of GORD. However, in rare cases the laparoscopic approach is not possible because it becomes difficult to visualize or handle organs effectively. In such instances, the traditional incision may need to be made to safely complete the operation.

A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Although hiatal hernias are present in approximately 15% of the population, they are associated with symptoms in only a minority of those afflicted.

Normally, the esophagus or food tube passes down through the chest, crosses the diaphragm, and enters the abdomen through a hole in the diaphragm called the esophageal hiatus. Just below the diaphragm, the esophagus joins the stomach. In individuals with hiatal hernias, the opening of the esophageal hiatus (hiatal opening) is larger than normal, and a portion of the upper stomach slips up or passes (herniates) through the hiatus and into the chest. Although hiatal hernias are occasionally seen in infants where they probably have been present from birth, most hiatal hernias in adults are believed to have developed over many years.

Types of Hiatal Hernia :-

• Sliding Hiatal Hernia: The most common (95%) is the sliding hiatus hernia, where the gastro-esophageal junction moves above the diaphragm together with some of the stomach.

• Rolling Hiatal Hernia: The second kind is rolling (or paraesophageal) hiatus hernia, when a part of the stomach herniates through the esophageal hiatus and lies beside the esophagus, without movement of the gastro-esophageal junction. It accounts for the remaining 5% of hiatus hernias.

The procedure is often done 'laparoscopically' through five small (1.5 cm) cuts (incisions) in your abdomen. The video camera and special instruments are then inserted through the incisions to do the repair. You may undergo a "Nissen" Hiatal Hernia procedure where the stomach is wrapped around the lower end of the esophagus to tighten up the sphincter.

Occasionally, the surgeon is unable to do the procedure laparoscopically and must convert to open surgery in order to make it safer for you. In this case, you will have an incision in the middle of your abdomen and your recovery will be longer. To help prevent blood clots from forming in your legs during and after surgery, sequential compression stockings may be applied.