What causes GER? How is GERD treated? It is necessary to take these consecutive steps: a) Changes in your lifestyle b) Drug treatment c) Surgery

Size: px

Start display at page:

Download "What causes GER? How is GERD treated? It is necessary to take these consecutive steps: a) Changes in your lifestyle b) Drug treatment c) Surgery"

Kory Leonard
5 years ago
Views:

3 When Gastric acids ascend the esophagus, they produce heartburn behind the sternum that can even reach the throat. Other symptoms are chronic cough, frequent vomits, and chronic affectation to the throat (many patients receive their diagnosis from otolaryngologist). What causes GER? When you eat, food goes from your mouth to the stomach through the esophagus. The lower esophageal sphincter is a valve that separates the esophagus from the stomach to prevent any gastric juices from ascending to the esophagus. When this sphincter is altered for any reason, gastric acids go into the esophagus with no control and produces GER. There are many causes for an alteration of the lower esophageal sphincter, but the most frequent one is hiatus hernia. However, the presence of this hernia does not mean that GER is going to happen, and it is even possible to suffer from GER without presenting a hiatus hernia. Some patients present an alteration of their lower esophageal sphincter from birth or due to their constitution. There are also external causes for this alteration, like alcohol, smoking, or doing vigorous exercise. How is GERD treated? It is necessary to take these consecutive steps: a) Changes in your lifestyle b) Drug treatment c) Surgery a) Changes in your lifestyle - Eat food which is easy to digest and avoid irritating elements like alcohol, spices, coffee, or large meals. - Avoid smoking and obesity. Mild exercise is recommended. - Elevate the head of the bed 20 cm. Reflux episodes are more frequent during the night. Do not go to bed after having your meal, but wait minutes for digestion to be completed. b) Drug treatment Nowadays, the most used drug is omeprazole and its derivatives. This drug inhibits the production of acid in the stomach and therefore the aggression to the esophagus is reduced. Besides, when gastric acids are reduced, the esophageal sphincter works better. It can be associated to other medicines in order to accelerate the emptying of the esophagus and the stomach, but this must be prescribed by your surgeon or the specialist on the digestive system. c) Surgery Those patients who do not respond to medical treatment or cannot follow it need surgery, as 90% of the cases can be solved with this treatment.

4 How is laparoscopic anti-reflux surgery performed? First of all you need to know that both laparoscopic and traditional open surgery are the same. The only difference is the approach that is made to the intervention. With open surgery, a big incision (20 cm) is done in the abdominal skin, and with laparoscopy we perform several small incisions (between 0.5 and 1 cm wide) and we introduce TV cameras and small instruments through them in order to see your viscera and proceed with the intervention. The lower esophageal sphincter is repaired or substituted, wrapping around the stomach to the esophagus as if it were a "tie". Thus, the stomach works as a sphincter and prevents the gastric acids from ascending to the stomach. The patient is given general anesthesia and gas (CO2) is insufflated into the abdomen. Thus, we can see all viscera using a TV camera and we do not need to do a big incision on the skin. The results vary depending on the type of intervention and the general state of the patient, but the main advantages are: -Reduction of postoperative abdominal pain - Shorter stay at hospital - Rapid tolerance to food - Rapid recovery of the intestinal function - Rapid return to normal life - Better aesthetic results and lower rate of hernia or problems in the wounds Are you candidate for laparoscopic anti-reflux surgery? The test performed (endoscopy, ph metry, and manometry) will indicate the most appropriate treatment for each patient. The surgeon will decide the most suitable technique, as each case and patient is different from the rest. Is it necessary to take any special test before the intervention? Apart from the regular preoperative study (analysis, radiography, electrocardiogram, anesthesiology), there are three tests that must always be performed, as they give information on any necessary surgical indication or technique:

5 a) Esophagogastroduodenoscopy b) Esophagogastric manometry c) Esophagogastric ph metry a) Esophagogastroduodenoscopy It consists on seeing inside the esophagus and the stomach. This is done introducing a tube through the mouth (the patient will be sedated) in order to see any damage in the esophagus (esophagitis) or any hiatus hernia, and check the presence of helicobacter pylori bacteria in the stomach. b) Manometry A thin tube is introduced through the nose and it is used for measuring the esophageal movements and the state of the lower esophageal sphincter. This makes deciding which anti-reflux surgical technique must be used possible. c) Ph metry It indicates the degree of the acid reflux and how often this happens per day. How is this intervention performed laparoscopically? The term laparoscopic surgery refers to the way in which the surgeon accesses to the abdominal cavity. Gas (CO2) is insufflated in the abdomen in order to introduce a TV camera and all the necessary equipment to repair the GER. The intervention is done looking at the screen that shows the images obtained by the TV camera in the abdomen. Once the stomach and the end part of the esophagus are liberated, the stomach is wrapped around the esophagus as if it were a "tie". Thus we can adjust everything in order to prevent the acids from ascending to the esophagus. What happens if laparoscopy is not feasible? The intervention will be done with open surgery performing an incision in the abdominal region. It is not a laparoscopic complication but a decision that the surgeon takes in order to ensure the most adequate or indicated technique for each patient. Proceeding with open surgery is based exclusively on the security of the patient. What happens after the surgical intervention? Depending on the patient and the type of intervention, the patient will be taken to the intensive or intermediate care unit before going to their room.

6 The patient will have a nasal tube until the nauseas disappear. This tube prevents any early complications. Sometimes it is not even necessary to use it. The patient will be able take liquids 24 hours after the intervention, and if they present a good tolerance to it, they will be given puree food after hours. The patient will have to eat puree food for the next 15 days in order to get used to their new situation progressively, as at first the patient can have difficulties in swallowing and they may notice that dried solid food like bread or meat "gets stuck". The patient will be able to get up the very same day the intervention takes place and will be discharged from hospital as soon as they can walk normally. If the reparation has been done laparoscopically, the patient can get to normal life in 7-10 days (except for physical exercise). The patient will have to visit the doctor 10 days after to get the stitches removed. The following checkup will take place 15 days after and the patient will be informed then about the next checkups. What complications may arise? They are rare, but hemorrhages and infections both inside and outside the abdomen may appear. Internal organs like the esophagus, the stomach, and the spleen can get damaged as well. Thromboembolic episodes can occur even if preventive drugs are prescribed. It is very important to recognize the complications in order to treat them as soon as possible. When should I call the doctor? - Temperature over 38º and shivering - Hemorrhages in the wounds - Food intolerance (liquids and puree food) - Nauseas and vomits with possible presence of blood, or dark stool with blood - Increasing abdominal pain or abdomen swelling - Incapability to urinate - Reddening or suppuration of the wounds - Respiratory symptoms like persistent coughing or costal pain

Hospi t alt el ephonenumber :+34917567800 Out pat

/ 902107471 Gener alsur ger yappoi nt mentt el

7 Hospi t alt el ephonenumber : Out pat i entappoi nt mentt el ephonenumber : / Gener alsur ger yappoi nt mentt el ephonenumber : Ext : 4136 Fax:

In two cases, fundamentally: - Bilateral inguinal hernia recurrent groin hernia, already treated with open surgery

In two cases, fundamentally: - Bilateral inguinal hernia recurrent groin hernia, already treated with open surgery 3.- What cases the hernia? It is unknown. Sometimes it is related to violent exercise or some trauma; you begin feeling discomfort and later the lump appears in the groin. It is also related to chronic