Anti-reflux surgery is surgery to correct a problem with the muscles at the bottom of the oesophagus (the tube from your mouth to the stomach).
Problems with these muscles allow gastro-oesophageal reflux disease (GORD).
This surgery can also repair a hiatal hernia.
GORD is a condition which causes food or stomach acid to come back up from your stomach into your oesophagus. It can cause heartburn and other uncomfortable symptoms. Reflux occurs if the muscles where the oesophagus meets the stomach do not close tightly enough.
A hiatal hernia occurs when the natural opening in your diaphragm is too large. Your diaphragm is the muscle and tissue layer between your chest and belly. Your stomach may bulge through this large hole into your chest. This bulging is called a hiatal hernia. It may make GORD symptoms worse.
A procedure called fundoplication is the most common type of anti-reflux surgery. During this procedure your surgeon will:
Surgery is done while you are under general anaesthesia (asleep and pain-free). Surgery usually takes 2 to 3 hours.
Endoluminal fundoplication is a new procedure that uses a special camera called an endoscope. The tube is passed down through your mouth and into your oesophagus. Your surgeon will place small clips on the inside where the oesophagus meets the stomach. These clips help prevent food or stomach acid from coming back. An endoscope is similar to a laparoscope. This procedure is done to help prevent reflux.
There is no waiting list. If you wish, your operation can usually be performed within a week or two or planned at a time of your choosing. For most patients with full private health insurance there will be some extra costs not covered by Medicare or your health fund. The cover provided by your health fund will vary according to which fund and which level of cover you are on and in some cases you may have to pay an "excess". It is your responsibility to check with your health fund prior to surgery. Full financial details will be provided to you prior to surgery. Occasionally other tests, procedures or specialist consultations may be necessary and some other costs incurred.
Providing you have private health insurance you can expect to be out of pocket around between $1900.00 - $2300.00 depending on which health fund you are registered with.
Public hospital waiting lists are very long and the surgery is usually carried out by trainee surgeons under the supervision of one of the specialist surgeons appointed by the hospital. There is no choice of surgeon in the Public Hospital and your LapSurgery Australia surgeon cannot not be involved in your operation.
Hospitals used by LapSurgery Australia for this surgery are:
If you do not have private health insurance, you can expect to be out of pocket between $7000.00 - $7500.00 depending on the hospital your surgery is performed at. Following your consultation with our surgeon our staff will be able to give you an informed financial consent prior to going ahead with surgery.
Please contact our office if you have any other questions in regard to costings for this surgery: (03) 9760 2777
Your doctor may ask you to have these tests:
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Although "heartburn" is often used to describe a variety of digestive problems, in medical terms, it is actually a symptom of gastroesophageal reflux disease. In this condition, stomach fluids like acid, bile or other digestive juices reflux or "back up" from the stomach into the oesophagus.
Heartburn is described as a harsh, burning sensation in the area in between your ribs or just below your neck. The feeling may radiate through the chest and into the throat and neck. Many adults experience this uncomfortable, burning sensation at least once a month. Other symptoms may also include the sour taste of acid in the mouth known as waterbrash, vomiting, difficulty swallowing and chronic coughing or wheezing.
You maybe also the backing up of fluid in the bending over position or when lying down in the horizontal position at night causing a choking sensation.
Other associated symptoms such as worsening of asthma, chronic hoarseness of voice can sometimes be secondary to reflux.
The risk of developing cancer of the oesophagus because of reflux is small. However, a precancerous condition known as Barrett’s Oesophagus can be a precursor of cancer and this condition is often associated with reflux. Surgery to treat reflux may reduce the chance of progression to cancer in selected cases.
Long term effects can occur. These include a tight narrowing of the oesophagus causing blockage, and in some cases a change in the lining of the gullet known as Barrett’s oesophagus can occur. In a small percentage of cases Barrett’s oesophagus can progress to cancer of the oesophagus
When you eat, food travels from your mouth to your stomach through a tube called the oesophagus. At the lower end of the oesophagus is a small ring of muscle called the lower oesophageal sphincter (LOS). The LOS acts like a one-way valve, allowing food to pass through into the stomach. Normally, the LOS closes immediately after swallowing to prevent back-up of stomach juices, into the oesophagus. GORD occurs when the LOS does not function properly allowing acid to flow back and burn the lower oesophagus. This irritates and inflames the oesophagus, causing heartburn and eventually may damage the oesophagus.
Some people are born with a naturally weak sphincter (LOS). For others, however, fatty and spicy foods, certain types of medication, tight clothing, smoking, drinking alcohol, vigorous exercise or changes in body position (bending over or lying down) may cause the LOS to relax, causing reflux. A hiatus hernia (a common term for GORD) may be present in many patients who suffer from GORD, but may not cause symptoms of heartburn. The hiatus hernia can also be repaired at the time of surgery.
Your specialist may recommend a Gastroscopy where a camera is passed down the oesophagus to confirm the diagnosis and check for a Hiatus hernia. On occasion other tests such as a Special Barium X-ray may be required.
An extremely good method of confirming the diagnosis and also checking for suitability for treatment with surgery is Manometry. This tests the how well the oesophagus is squeezing food down toward the stomach with the use of a special catheter passed into your oesophagus via-the nose. This is a mandatory requirement prior to surgery. The specialised equipment to perform the test is available at LapSurgery Australia and trained staff can perform the test where indicated as a same day procedure.
Another test that is extremely good at confirming the diagnosis is a 24-hour ambulatory pH test. This is a test done to study the nature of fluid backing up into the oesophagus and correct it to the symptoms. The pH test it also requires a fine catheter to be placed in the oesophagus which monitors the fluid that is backing up. The test is carried out over a 24-hour period. This test can be done at the same time that the manometry is carried out. The specialised equipment to perform the test is available at LapSurgery Australia and trained staff can perform the test where indicated as a same day procedure.
GORD is generally treated in three progressive steps:
1. Lifestyle Changes In many cases, changing diet and taking over-the-counter anti-reflux medications can reduce how often and how harsh your symptoms are. Losing weight, reducing or eliminating smoking and alcohol consumption, and altering eating and sleeping patterns can also help.
2. Drug Therapy If symptoms persist after these life style changes, drug therapy may be required. Antacids neutralize stomach acids and over-the-counter medications reduce the amount of stomach acid produced. Both may be effective in relieving symptoms. Prescription drugs such as Nexium, Somac, and Pariet (PPI drugs) may be more effective in healing irritation of the oesophagus and relieving symptoms. This therapy needs to be discussed with your surgeon. There is some controversy about lifelong therapy using these medications. In some cases, the drugs are not effective in controlling reflux, particularly when there is large amounts of fluid backing up due to a weak valve at the junction of the oesophagus and stomach. It may be appropriate to consider surgery in selected cases where drug therapy is ineffective in controlling symptoms
3. Surgery Patients who do not respond well to lifestyle changes or medications, or those who continually require medications to control their symptoms, can choose to live with their condition or may choose to undergo a surgical procedure. Surgery is very effective in treating GORD.
The advantage of the laparoscopic approach is that it usually provides:
Although laparoscopic anti-reflux surgery has many benefits, it may not be appropriate for some patients. You should obtain a thorough medical evaluation by a surgeon qualified in laparoscopic anti-reflux surgery in consultation with your primary care physician or Gastroenterologist to find out if the technique is appropriate for you. In all cases special tests such as Gastroscopy, Manometry and pH studies will need to be carried out prior to considering surgery.
In a small number of patients, the laparoscopic method is not feasible because of the inability to visualise or handle the organs effectively. Factors that may increase the possibility of converting to the "open" procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, or bleeding problems during the operation. The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication. The decision to convert to an open procedure is strictly based on patient safety.
Studies have shown that the vast majority of patients who undergo the procedure are either symptom-free or have significant improvement in their GORD symptoms. Long-term side effects to this procedure are generally uncommon.
Although the operation is considered safe, complications may occur as they may occur with any operation. Complications may include but are not limited to:
Be sure to call your surgeon if you develop any of the following: