Oesophageal Reflux Surgery

Summary:

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).
This surgery can also repair a hiatal hernia.
Price: up to $500 with adequate Private Health Insurance (self-pay options are available)

Gastro-Oesophageal Reflux Disease (GORD)

‘Gastro oesophageal Reflux Disease’ refers to abnormal amounts of acid produced by the stomach coming up the oesophagus and causing typical symptoms such as heartburn or acid taste in the mouth, which can be aggravated by fatty foods, alcohol, eating large meals, and lying down or bending over after eating.

This occurs because the normal mechanisms that prevent acid reflux have failed – usually due to age, genetics, stretching of the tissues, weight gain and, rarely, trauma.

Over time the acid damages the oesophagus and can lead to narrowing/scarring or potentially even precancerous or cancerous changes.

Anti-acid medication reduces the production of acid, which means the reflux liquid does not cause as much damage. However, if the antiacid medication is not taken, all the symptoms return. In some cases the medication might help but not completely make the symptoms go away. This is because medication does not address the anatomical reasons for reflux. Surgery, on the other hand, aims to correct these factors to get rid of the reflux, allowing patients to get off these tablets.

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Oesophageal reflux anti-reflux surgery diagram

A procedure called fundoplication is the most common type of anti-reflux surgery. During this procedure your surgeon will:

First repair the hiatal hernia with stitches. The surgeon will tighten the opening in your diaphragm to keep your stomach from bulging through.
Then use stitches to wrap the upper part of your stomach around the end of your oesophagus. This creates pressure at the end of your oesophagus and helps prevent stomach acid and food from flowing back up.
Surgery is done while you are under general anaesthesia (asleep and pain-free). Surgery usually takes 2 to 3 hours.
This surgery can be performed very safely in a ‘minimally invasive/keyhole’ way. In rare circumstances open surgery may be required, particularly if there has been previous surgery in the area.

Gas bloat, which makes it hard to burp or vomit. It also causes bloating after meals.
These symptoms slowly get better for most people.
Pain and difficulty when you swallow, for some people. This is called dysphagia. For most people, this goes away in the first 3 months after surgery.
Damage to the stomach, oesophagus, liver, or small intestine. This is very rare.
Respiratory complications, such as a collapsed lung. This is also rare.
Recurrence of the hiatal hernia.

What tests will be needed:

Blood tests upper endoscopy.
Almost all people who have this procedure have already had this test. If you have not, we will need to arrange this.
Other tests, such as Manometry (to assess the function of your oesophagus) and pH monitoring (to see how much stomach acid rises into your oesophagus).

During the week before your surgery:

You may be asked to stop taking aspirin, ibuprofen, vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other drugs or supplements that affect blood clotting several days to a week before surgery.
Ask your doctor which drugs you should still take on the day of your surgery. Your doctor or nurse will tell you when to arrive at the hospital.

On the day of your surgery:

Do not eat or drink anything after midnight the night before your surgery.
Take your drugs your doctor told you to take with a small sip of water.
Shower the night before or the morning of your surgery.

Anti-reflux surgery is a safe operation.
Heartburn and other symptoms should improve after surgery. But you may still need to take drugs for your heartburn after surgery.
Some people will need another operation in the future to treat new reflux symptoms or swallowing problems. This may happen if the stomach was wrapped around the oesophagus too tightly, the wrap loosens, or a new hiatal hernia develops.

With Private Health Insurance

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.

Without Private Health Insurance

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.

If you do not have private health insurance, you can expect to have a high out of pocket costs. Following your consultation with our surgeon our staff will be able to give you an informed financial consent prior to going ahead with surgery.

Hospitals used by LapSurgery Australia for this surgery are:

Mulgrave Private Hospital – Mulgrave
Knox Private Hospital – Wantirna.
Peninsula Private Hospital – Frankston.
St John of God Berwick Hospital – Berwick.

The team at LapSurgery Australia are recognised for their exceptional and major contribution to the Government sponsored Bariatric Safety Registry (BSR). The BSR tracks surgical complications and provides an unbiased safety record for weight loss surgery.

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