Surgery for gastroesophageal reflux is indicated when treatment with medication and dietary care does not bring results, and complications such as ulcers or the development of Barrett’s esophagus begin to appear, for example.
Surgery for reflux can be performed using different techniques, the most common being laparoscopic Nissen fundoplication, in which the doctor creates an anti-reflux valve by wrapping the upper part of the stomach around the esophagus, which helps to prevent stomach acid from rising into the esophagus.
This surgery is carried out under general anesthesia and through small cuts in the abdomen, and full recovery takes about 2 months, and in the first few weeks it is necessary to eat only liquids, which can lead to slight weight loss.
When is it indicated
Surgery for gastroesophageal reflux is indicated in the following situations:
- Failure to provide medical treatment with medication and dietary care;
- Dependence on the use of medications to control reflux symptoms;
- Difficulty adhering to medication treatment or developing side effects to medications;
- Complications such as esophageal ulcers, severe esophagitis or Barrett’s esophagus;
- Repeated episodes of pneumonia due to aspiration of stomach acid;
- Asthma related to gastroesophageal reflux.
Furthermore, the indication for surgery also depends on the length of time the person has had reflux, the intensity and frequency of symptoms and the person’s willingness to undergo surgery to resolve the condition. Check out the treatment options for reflux before surgery.
How to prepare
To prepare for gastroesophageal reflux surgery, it is recommended to fast for approximately 8 hours, starting at midnight the night before surgery. However, you should take your usual medications normally with a little water and the antibiotic prescribed by your doctor.
Before performing surgery, the doctor will order surgical risk tests and blood tests to assess your general health status. See which tests should be carried out for surgical risk.
Furthermore, to prepare for reflux surgery, it is important to clarify with your doctor any questions you may have about the surgery and recovery, as well as informing your doctor of all medications, vitamins and nutritional supplements you frequently take. You should also inform yourself if you have any allergies or other health problems.
In some cases, your doctor may recommend stopping anticoagulant treatment a few days before surgery to prevent bleeding.
It is also recommended not to smoke for at least 4 to 6 weeks before surgery, nor to consume alcoholic beverages before reflux surgery.
How is the surgery done
Reflux surgery is performed in the hospital by a digestive system surgeon under general anesthesia. Therefore, before starting the surgery, saline solution is administered into the vein by the nurse, so that the anesthetist can perform general anesthesia and also to hydrate and administer medications.
Typically, the surgery is performed using laparoscopy, in which thin tubes are inserted through small cuts in the skin. The doctor can observe the inside of the body and perform surgery through a camera placed at the end of one of the tubes. Understand how laparoscopy is performed.
During surgery, the doctor wraps the upper part of the stomach around the esophagus, creating an anti-reflux valve, which reinforces the esophageal sphincter to prevent stomach acid from rising up into the esophagus. Additionally, the doctor can also correct hiatal hernia, which is one of the causes of gastroesophageal reflux.
What is recovery like?
Recovery from reflux surgery is quick, with little pain and little risk of infection, and the person is generally discharged 1 day after surgery and can return to work after 1 or 2 weeks. However, for a faster recovery, it is recommended:
- Avoid directing for at least 10 days;
- Avoid having intimate contact in the first 2 weeks;
- Don’t lift weights and resume physical exercise only after 1 month or after authorization from the doctor;
- Take short walks at home throughout the dayavoiding sitting or lying down for a long time.
Furthermore, it is recommended to return to the hospital or go to the health center to treat the wounds from the surgery. For the first 2 days, it is important to only bathe with a sponge to avoid getting the dressings wet, as this increases the risk of infection.
During recovery, your doctor may also recommend the use of antibiotics, anti-inflammatories, or pain relievers to reduce discomfort.
What to eat after surgery
Due to the pain and difficulty swallowing, it is recommended to follow this type of regimen:
- Feed only liquids during the 1st weekwhich may extend until the 2nd week, according to the patient’s tolerance;
- Switch to a soft diet from the 2nd or 3rd weekeating well-cooked foods, purees, ground meat, fish and shredded chicken;
- Gradually start a normal dietaccording to the doctor’s tolerance and approval;
- Avoid carbonated drinks during the first few monthssuch as soft drinks and carbonated water;
- Avoid foods that produce gas in the intestinesuch as beans, cabbage, eggs, peas, corn, broccoli, onions, cucumbers, turnips, melons, watermelons and avocados;
- Eat and drink slowlyto avoid bloating and stomach pain;
- Chew food well and eat in small quantities.
The feeling of pain and a full stomach can lead to weight loss due to a reduction in the amount of food eaten or difficulty swallowing, which improves in a few weeks.
In addition, it is also common to experience hiccups and excess gas, and it may be necessary to take medications such as simethicone to reduce these symptoms. See more details about reflux feeding.
Possible complications
Reflux surgery is quite safe, especially when performed laparoscopically, however, some complications may arise, such as:
- Bleeding;
- Thrombosis in the lower limbs;
- Pulmonary embolism;
- Infection at the cut site;
- Hernia formation at the site of the cuts;
- Scar formation with keloids;
- Perforation of the stomach or esophagus;
- Injury to organs close to the stomach, such as the spleen or liver;
- Pneumothorax;
- Allergic reactions to anesthesia.
Depending on the severity, these complications may lead to the need for the person to undergo surgery again through conventional surgery, made with a large cut in the abdomen, instead of the laparoscopy procedure.
Warning signs to go to the doctor
In addition to the return appointment, you should seek medical advice if you experience a fever above 38ºC, severe pain, redness, blood or pus in the wounds, frequent nausea and vomiting, frequent tiredness and shortness of breath and/or abdominal pain and persistent swelling.
These symptoms may indicate complications from surgery, and it is recommended to go to emergency care to treat and prevent further complications.
