Surgery for Reflux Disease

Learn about acid reflux, and the treatment of Hiatus Hernias

Many people suffer from “heartburn”, which is technically referred to as gastro-oesophageal reflux disease (GORD).

So, what is Gastro-Oesophageal Reflux Disease (GORD)?

In GORD stomach acids accidentally passes “back up” from the stomach into the oesophagus.

This may cause a harsh, burning sensation felt behind your breast bone. Many people experience this uncomfortable, burning sensation at least once a week.

Other symptoms may also include:

• An unpleasant taste in the back of your mouth
• Regurgitation, particularly on leaning forward
• Difficulty swallowing and
• Chronic coughing or wheezing

So, what causes GORD?

At the lower end of the oesophagus is a one-way valve called the lower oesophageal sphincter (LOS).

GORD occurs when the LOS does not work properly allowing food and stomach acid to flow backwards into your oesophagus. This irritates and inflames the oesophagus, causing what is felt as heartburn.

What contributes to GORD?

GORD has many causes and is not just the result of too much stomach acid production.

Some people are born with a naturally weak sphincter (LOS).

For others, however, risk factors include:

  • Fatty and spicy foods,
  • Obesity
  • Pregnancy
  • Smoking
  • Drinking alcohol
  • A hiatal hernia

A hiatus hernia, is a weakness in diaphragm that allows part of the stomach to enter the chest cavity, may be present in many patients who suffer from GORD, but in many will not cause GORD.

How is GORD treated?
01.
Lifestyle Changes

In many cases, changing diet and taking over-the-counter antacids can reduce how often and how harsh your symptoms are. Losing weight, reducing smoking and alcohol consumption, and altering eating and sleeping patterns can also help. Even with a medium hiatal hernia many patients have improvement in their GORD by making these lifestyle changes and taking medication.

02.
Medication

If symptoms persist after these lifestyle changes, drug therapy may be required.

Antacids neutralise stomach acids.

Proton-pump inhibitors, like omeprazole, may be more effective in healing irritation of the oesophagus and relieving symptoms.

03.
Surgery

In the right patient, surgery is a very effective and well tolerated treatment. The goal of anti-reflux surgery is for you to have your symptoms cured so that you will no longer have to take any medication and will not have any breakthrough symptoms.

How is laparoscopic anti-reflux surgery performed?
  1. The stomach is pulled down in to the abdominal cavity
  2. The hiatal hernia is  repaired with stitches
  3. The “valve” between the oesophagus and the stomach is reinforced by wrapping the top of the stomach around the bottom of the oesophagus.

Through five small 5 – 10mm incisions we enter the abdomen cavity. The laparoscope, which is connected to a tiny video camera, allows the surgeon a magnified view of the patient’s internal organs on a television screen. After the abdomen is expanded by pumping carbon dioxide gas into it, the entire operation is then performed though the small incisions.

Most patients go home the day after the operation off their anti-reflux medication and on a pureed diet for three weeks. They are back to work at 2 weeks but no heavy lifting for 4 weeks

What are the risks of laparoscopic anti-reflux surgery?
  • Rarely an injury to the oesophagus, spleen, stomach may occur
  • Injury to the Vagus nerve resulting in poor stomach function (which may need surgical widening of gastric outlet)
  • In 1 in 100, the laparoscopic method is not feasible or safe
What are the expected results after laparoscopic anti-reflux surgery?
  • The vast majority of patients are either symptom-free or have significant improvement in their GORD symptoms.
  • 15% -20% of patients may get a recurrent hiatus hernia but only a small percentage of patients get recurrent symptoms from this.
  • The long term evidence shows that 80% of patients are still symptom free 10 years after surgery.
Are there side-effects to this operation?
  • Long-term side effects to this procedure are generally uncommon (<4%)
  • Some patients develop temporary difficulty in swallowing immediately after the operation. This usually resolves within one to three months.
  • A sloppy diet will be required in the six weeks following surgery and a suggested plan of eating is included on discharge.  
  • Occasionally, these patients may require a simple procedure to expand the oesophagus (endoscopic dilatation) or rarely re-operation (<1%).
  • The ability to belch and or vomit may be limited following this procedure. Some patients complain of stomach bloating. Avoid fizzy drinks.
What to expect after Laparoscopic Surgery

You may find you have some discomfort after your operation. It is common to have pain in your shoulders this is normally nothing to worry about and it will slowly improve over a couple of weeks. If you have been given painkillers and anti sickness medicines Please take them regularly whilst you have pain.

You may have a bloated feeling and have difficultly in burping this is known as Gas Bloat  It is advisable to slow down when eating  to avoid this however it will resolve with no long term problems but it is better to avoid it.

Your wound are stitched with dissolvable stitches so there is no need to have them removed It is advised that you keep the wounds dry for the first 48hrs after this you can shower and change the dressings. After 5 days the dressings can be removed and left open if they are clean and dry.

Any problems or concerns with your wound you can contact your practice nurse who will be able to advise you.

Dietary advice for after your Hiatus Hernia repair
Following the surgery it is important to follow a special diet afterwards as swallowing may be difficult as a result of swelling around the oesophagus (gullet) in addition to the tightness from the stitches.

 Patients who also follow the diet advice have better outcomes and are less likely to get recurrent symptoms. It may take a month or more for swallowing to feel normal again with all foods.

It is important to realise that you may always have a degree of difficulty in swallowing large amounts of bread or red meat. We would also advise not to have too many fizzy drinks as this may cause excessive gas bloating.

Four stages of diet are advised. In each stage, when swallowing feels normal, you can move on to the next stage.

Most importantly​:
  • Have small frequent meals and snacks, rather than large meals
  • Eat slowly and chew foods well
  • Have moist foods
  • If any food sticks, stop eating, relax and allow time for food to clear.
    Try and drink water to wash the food down; if that fails, try some soda water. If food remains stuck, contact the hospital ward or your surgeon.

Avoid the following until swallowing is free and easy (usually four weeks):

  • Fresh bread
  • Rice
  • Cake
  • Hard biscuits
  • Grilled and fried meat, especially steak, chicken, unless pureed, minced or finely chopped
  • Aerated drinks (soft drinks, milkshakes – unless soda water is required to relieve blockage)
  • Highly spiced foods (avoid for 6 weeks).
Stage 1: Day 1 to day 7 post surgery

Fluids and semi-fluid items only – these should be smooth with no lumps

  • Water, juice, cordial (no fizzy drinks)
  • Milk – plain, flavoured
  • Tea, coffee (not too hot)
  • Soups (strained or finely pureed no lumps)
  • Ice-cream, custard, jelly
  • Yoghurt (plain, vanilla or honey – not with seeds or pieces of fruit)
  • Smoothies (no lumps)
  • Gravy, white sauce (no lumps)
  • Food pureed to a thin consistency (no lumps).

A food processor or blender is useful.

Breakfast ideas
Choose from: glass of milk, smooth yoghurt, custard, jelly, tea/coffee, juice. NO LUMPS

Lunch ideas
Choose from strained soup, puree potato Swede and carrot, gravy, white sauce, tomato sauce, jelly, custard, ice-cream, cordial, juice. NO LUMPS

Dinner ideas
Choose from strained soup, puree potato, puree carrot or Swede, gravy, white sauce, ice-cream, jelly, tea, coffee, and juice. NO LUMPS
Between meals snack ideas: milk (plain or flavoured), cordial, juice, smooth yoghurt fortified

Stage 2: One week post surgery - for 2 weeks

Mashed and very soft foods only – soft lumps able to be mashed with a fork.

Add in:

  • Porridge, breakfast cereals such as Weetabix, Cornflakes, rice crispies, well softened with milk or hot water
  • Fruit – fresh fruit (soft, well ripened) stewed or tinned fruit (soft or pureed)
  • Vegetables – well cooked, soft, mashed or pureed
  • Pasta (spaghetti, noodles) well cooked, soft
  • Pureed meats, pureed chicken – can be with gravy in a thick soup, or served with mashed/pureed vegetables
  • Fish – fresh (take care to remove all bones) or canned tuna, salmon (mashed, no bones)
  • Eggs – soft boiled, scrambled, and poached.

Breakfast ideas
Choose from porridge or softened cereal with milk and sugar, soft boiled egg.

Lunch ideas
Choose from smooth soup, mashed tuna or salmon with noodles and white sauce, pureed meat with mashed or pureed vegetables, pureed or mashed fruit.

Dinner ideas
Choose from pureed braised meat, poached fish fillets with white sauce, mashed potato, pureed vegetables, pureed or mashed fruit, and custard.

Between meals snack ideas: soft or mashed fruit, custard

Stage 3: Three weeks post surgery - for 2 weeks

Light foods with more texture – chew well

Add in:

  • Tender meats, mince, stews
  • Chicken – minced or finely chopped
  • Salads (remove skin from peppers, cucumber and tomatoes if having difficulty)
  • Toast
  • Biscuits
  • Alcohol in small quantities if desired.

Breakfast ideas
Choose from any of the above, plus toast with spreads, baked beans, cheese and tomato.

Lunch Ideas
Choose from any of the above plus soup, tender braised meat and vegetables, fish in white sauce with or without cheese, canned spaghetti, creamed beans kidney, butter or baked (well cooked), cheese, salad, soft fruit, tinned or fresh.

Dinner ideas
Any of the above, plus pasta with bolognaise sauce, meat casserole, cottage pie, steamed fish, well cooked vegetables, soft fruit, fresh or tinned.

Between meals snack ideas: ripe fresh fruit, cheese, biscuits.

Stage 4: gradual return to normal eating - Five weeks post surgery

Gradually add in firmer foods. Try the food in the avoid list in small amounts one by one. Chew these foods well.

After about Five weeks, you should be able to eat a full range of foods.

However, you are advised to:

  • Continue with small meals and between-meals snack if need to satisfy your appetite rather than large meals
  • Continue to chew all foods well.
  • Eat slowly allowing time for food to pass into the stomach

If you are unable to eat a proper diet after about four weeks, please contact your surgeon’s secretary as your surgeon may wish to see you earlier than planned in the Outpatient Department.

Looking for More Informaton?

To find out more call us on
03 464 0970