Gastroesophageal reflux disease (GERD), gastro-oesophageal reflux disease (GORD), gastric reflux disease, acid reflux disease, or reflux (GERD) is a chronic digestive disease that occurs when stomach acid or, occasionally, bile flows back (refluxes) into your food pipe (esophagus). The backwash of acid irritates the lining of your esophagus .The esophagus is the tube that carries food from the mouth to the stomach. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. When acid reflux occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the esophagus it may cause a burning sensation in the chest or throat called heartburn or acid indigestion.
The main symptom of GERD in adults is frequent heartburn, also called acid indigestion—burning-type pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen.
What causes Gastroesophageal reflux disease (GERD)?
GERD occurs when the anti-reflux mechanisms at the junction between the esophagus and the stomach do not work properly. This may be due to a weakness in the lower esophageal sphincter that is supposed to close off the esophagus from the stomach and stop acid reflux from happening. Other factors that may contribute to GERD include – Obesity, pregnancy, Smoking and lifestyle.
Laparoscopic Fundoplication Surgery for Gastroesophageal Reflux Disease (GERD) at Super Speciality Hospitals in India
Laparoscopic Fundoplication is a safe procedure, and can provide less postoperative morbidity in experienced hands. This is a surgical procedure done for Gastroesophageal Reflux Disease (GERD). Fundus of the stomach which is on the left of the esophagus and main portion of the stomach is wrapped around the back of the esophagus until it is once again in front of this structure. The portion of the fundus that is now on the right side of the esophagus is sutured to the portion on the left side to keep the wrap in place. The Fundoplication resembles a buttoned shirt collar. The collar is the fundus wrap and the neck represents the esophagus imbricated into the wrap. This has the effect of creating a one way valve in the esophagus to allow food to pass into the stomach, but prevent stomach acid from flowing into the esophagus and thus prevent GERD.
Laparoscopic fundoplication is a useful method for reducing hospital stay, complications and promotes early return to normal activity. With better training in minimal access surgery now available, the time has arrived for it to take its place in the surgeon’s repertoire.
Advantages of Laparoscopic Fundoplication Procedure for Gastroesophageal Reflux Disease (GERD)
Fundoplication is performed as a Laparoscopic procedure as this new approach requires only five small incisions. Patients experience minimal pain and recover faster.
The laparoscope, which is a telescopic videocamera, gives a better view of the internal organs than the traditional open procedure. Magnified images viewed on the video monitor reveal internal structures, including blood vessels in exquisite detail.
- Lesser blood loss than the traditional approach.
- Lesser rate of infection.
- Lesser complications.
- Minimal pain.
- Faster recovery- The patient can return to work in one or two weeks.
Hiatal Hernia
A Hiatal Hernia occurs when part of your stomach pushes upward through your diaphragm. Your diaphragm normally has a small opening (Hiatus) through which your food tube (esophagus) passes on its way to connect to your stomach. The stomach can push up through this opening and cause a hiatal hernia.
In most cases, a small hiatal hernia doesn't cause problems, and you may never know you have a hiatal hernia unless your doctor discovers it when checking for another condition. But a large hiatal hernia can allow food and acid to back up into your esophagus, leading to heartburn. Self-care measures or medications can usually relieve these symptoms, although a very large hiatal hernia sometimes requires surgery
Types of Hiatal Hernia
Sliding Hiatal Hernia: Shoulder arthroplasty - With loss of cartilage the patient will suffer severe shoulder arthritis. This will eventually make surgical treatment is necessary.
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.
Laparoscopic (Key Hole) Hiatal Hernia Surgery - A Major Advancement in Modern Medical Science
The procedure and technique used in shoulder surgery varies depending on the specific surgery. Shoulder surgery is generally performed using one of the following approaches:
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.
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