Antireflux Procedures

Gastro esophageal reflux disease is a very common condition. The most common symptom is the well known heartburn. Having heartburn occasionally is acceptable and does not necessarily needs treatment. We are concerned when a person experiences heartburn about 2-3 times a week, or when medication is necessary to control the symptoms.
One of the biggest challenges we have now a days is that people self medicate to treat this condition. The medications to treat the symptoms of reflux can be purchased over the counter.
Despite the fact that there are warnings in the label warning to seek medical help if reflux persists, most people do not pay attention and continue taking the medication. Heartburn is a symptoms and not the condition in itself. It is our body's indication that something is not working well. Heartburn occurs due to the damaging effects of acid from the stomach going up into the esophagus and causing damage to the lining of the esophagus.
If this damage continues long term, it can lead to more serious damage, like ulcerations and even in a small percentage of people even cause cancer.
It is ok to get some relief of indigestion or heartburn if it occasionally occurs, but it is not ok to continue treating it indefinitely since the main problem is not solved and we are only treating a symptom, not the cause.
Some people are harder to diagnose due to atypical symptoms that indicate reflux. Some may present with a chronic cough, adult onset asthma, sour taste in the mornings, chocking at night, damage to tooth enamel, difficulty or pain swallowing, bad breath, etc.
People who suffer these, and many other symptoms could be suffering from GERD and not even know it.
The cause of GERD is a mechanical problem in which the valve and sphincter responsible of preventing the gastric contents from going up, are damaged. As a consequence the acid and gastric contents go up into the esophagus and the esophagus linning is not prepared to handle this acid.
This causes inflammation and irritation and eventually damage.
Sometimes this disruption and mecahnical failure is caused or agravated by a hiatal hernia. Not all hiatal hernias need repair, but when they are symptomatic or large, they should be repaired.
Traditionally GERD is initially treated medically, but when medication is not enough or when medication is not well tolerated, or contraindicated, we have procedures to correct it. There are many procedures to choose from. Some more and some less invasive. They do work and solve the mechanical problems that are causing the reflux and allows the patient to stop all medications in most cases.
The gold standard of all the procedures and devices done now a days is called the Nissen Fundoplication. In a simple way of explaining it, it is wrapping the top part of the stomach over the distal part of the esophagus. This will create and re establish the valve mechanism that prevents the food and acid from going up into the esophagus. This is extremely effective and many patients get complete resolution. The operation is so efficient that at times it is hard for patient to vomit or belch.
During this procedure in many instances we also repair a hiatal hernia if present.
The operation is performed now a days laparoscopically or robotically with a 24 hour stay. The patient is placed in a liquid diet for a period of a week or less and then advanced to a regular diet as tolerated.
The most common symptoms after the operation si bloating and that is ussually treated with Gas X or generic symethicone. It usually resolves withing a week or two. Some people experience diarrhea or difficulty swallowing large pieces of food in the beginning, but usually all resolves in a few weeks.  We stay follow you in the office until all these symptoms resolve.
Based on the success of this operation, there has been many other procedures developed that mimic this operation. All of these geared to decreasing the invasiveness of the procedure and attempting to get the same results that are obtained with a Nissen fundoplication.
One of the most recent devices is the LINX procedure and that is a very promissing device, recently adopted in the USA and that is growing by leaps and bounds with a good result track record so far. You can click here for more information regarding that device

It is important that each patient is evaluated and that the treatment options are personalized to each patient particular needs. that is why each patient will at least need an upper endoscopy to asses the damage and conditions of the linning of the esophagus and stomach. Also at times we leave a probe called Bravo probe, to measure acid and get an objective idea of the level of reflux and if the patient is a surgical candidate we do an esophageal manometry to determine contractility of the esophagus and assure that the operation will be well tolerated.


RISKS OF SURGERY

  • Bleeding - as in any surgical procedure this can happen and we have ways to control it an minimize it.

  • infection - very infrequent and unlikely in this operation

  • esophageal perforation - small risk for this to happen, but it can happen since we are working around and with the esophagus. If recognized immediately is easily handled and if recognized lateer then there are more serious consequences and would require another surgery to repair or a stent to patch.

  • difficulty swallowing - everyone has some trouble swallowing in the beginning and that is due to the wrap. We do the wrap around a bougie or dilator to assure that there is enough space for food to pass. At times due to swelling from surgery, in the first week after surgery the patient may have a feeling of things not passing down, specailly large pieces of food, but that usually resolves. If not, we could dilate the esophagus, but we like to avoid that since it may disrupt the proedure.

  • Stomach injury - we devascularize part of the stomach to mobilize it and do the wrap. the stomach rarely is affected by this, but in rare instances this necessary step could result in astomach injury that can be repaired.

  • Diarrhea - some people have this for one of two reasons. One could be injury to one or both vagus nerves that run in front and behind the esophagus and the other we believe is caused by the need of the stomach to empty faster since there is no escape valve above. Either way, this ususllay resolves spontaneously or if not is treated with antidiarrhea medication.

  • Lung collapse - on rare instances while dissecting and clearing the esophagus we get in the lower part of the chest and we can injure the lining of the lung. Although sounds serious the only issue this carries is that the lung collapses and we are forced to place a chest tube for 24 hr while it heals . If this were to happen, it is easily treated.

  • Liver injury - during the procedure we have to mobilize the L lobe of the liver through retraction. At times it gets somewhat beat or injured, but luckily it heals promptly and it is very forgiving. Of course we try to avoid this at all cost, but when it happens we see some liver enzyme elevation that will subside in the period of abou a week.

Lugo Surgical Group

150 Pine Forest Dr,,

Shenandoah, TX 77384

Phone. 832-377-5846

Email. lugosurgicalgroup@gmail.com