Anti Reflux Surgery (GERD, GORD)

http://www.sydneygastricbanding.com.au/ ... rgery.html
(Note they mention GORD rather than GERD but am assuming it is the same).

I mentioned recently I would be seeing a specialist who offers anti-Reflux surgery. The procedure involves keyhole surgery into the top of the stomach where the doctor operates to get the portion of the stomach that has gone outside the sphincter muscles back inside, he draws this area back, readjust the muscles & sews it all up.

It seems he has been doing this type of operation for quite a few years. In my visit to him I explained I had been to a clinic about 7-9 years ago after severe heartburn & was diagnosed as having (what I understand to be GERD). I have been on a medication called 'pariet' for many years now & it seems to have worked well as far as I am concerned.

Because I also went to an ENT recently who wants to do some housekeeping in the nasal area, I decided to investigate the anti-Reflux options then consider what should come 1st. The ENT wants to remove polyps, straighten deviated septum, turbinate reduction + remove enlarged tonsils.

The Visit to Dr Florica was very informative. Am to undergo an endoscopy early July to take a look at the condition of the area involved. Dr Florica wants to confirm if it is just acid or if there is bile reflux as well & the general state of the stomach entrance.

This is what Dr Florica told me ...

> The operation is 90% successful (for the 1st 2 years) then 70% successful (in the next 2 years). By this he means, that the muscles start to slacken a bit & that varies with the patient. But in reality after 4 years 30% of patients are back where they were before.

> The operation is about as effective as taking 'Pariet'. If Pariet works, generally so will the operation.

> There are 2 types of reflux, one is stomach acid (reduced by 90% using Pariet) & the other is bile. This can't be stopped with Pariet. He said to me it seems Pariet has worked & does work & maybe at my age it might be quite ok to keep taking Pariet.

> The real beneficiaries of the operation are people who are young & don't want to be taking Pariet for the next 40+ years and people who have bile reflux. The procedure stops all types of reflux (including air escaping as burps).

> I mentioned to him I get mild aerophagia from my xPAP therapy & he commented that one side effect of his operation is that it prevents burping so that any air or acid won't come out but can go in. So for anyone considering this operation, they need to weigh up that side effect (all else being equal, that would likely be a showstopper for me).

> He added that anyone with chronic or serious sinus infections, may also find that that works against them in that it may well have caused or triggered the GERD (GORD?) in the first place. Nasal drip is a common trigger.

> Dr Florica also said that if the Endoscopy was ok, he would (if I wished to proceed) want me to wear a stomach pressure sensing monitor for a few days so he could measure stomach pressures at various times night & day. Then if that all checks out they could proceed with an operation.

From my perspective, I don't see a need to have this op but because the Endoscopy is covered completely by medical insurance he suggested I go ahead with that part so he can at least give me a status report. He was pretty matter of fact about me perhaps being better off staying on Pariet. i.e. He was not trying to 'sell' me an operation just for the sake of it & that sure made me feel at ease.

Hope this info proves helpful as I learned a lot from the visit. The link above has a video of the actual operation being performed.

DSM

GORD -- Gastric Oesophageal Reflux Disease.... ahh, those British and America spelling variations...

Why assume when you can find it out? I googled "medicine GORD" and got an example:

http://ebm.bmj.com/cgi/content/extract/14/2/54

ozij wrote:GORD -- Gastric Oesophagal Reflus Disease.... ahh, those British and America spelling variations...
http://ebm.bmj.com/cgi/content/extract/14/2/54

Ozij,

A funny aspect to this GERD GORD is I though my doc had spelled it incorrectly & wrote e over the o - then I visited the specialist's web site & thought uh-o & tried to undo my alteration

This GP that I visit works in a fairly simple practice in a working people's suburb near to my office. Most patients attending this practice would not have private health insurance & their fees are very low. I have been seeing him for a few years & we get on well. I got a big surprise when after his name on the referral was written 'Adjunct Professor of Medicine at Univ of Western Sydney'. The Uni is a bout 5 Kms down the road from this clinic. I had wondered how & why he knew so many interesting specialists. A couple have said to me - oh Dr Ron & I were at Uni together

Seems this doc has no need for an expensive high charging practice. He certainly earned even more of my respect than he had before.

DSM

Hi DSM

I had the Nissan Fundoplication by keyhole surgery in 2007. It was not a success.

The 3 tests I had beforehand were a manometry test, to see how strong my esophegal muscles were. If my muscles were weak, and I had a full fundoplication, then the food would not get into the stomach, and I would not be able to eat.

I also had a 24 hour Ph study, to see how much reflux I was having over a 24 hour period. This involved having a tube and sensors down my esophagus, and attached to a recording machine hanging round my neck.

Finally, I had a Barium Swallow, to take x-rays of my esophagus.

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Your comment - The procedure involves keyhole surgery into the top of the stomach where the doctor operates to get the portion of the stomach that has gone outside the sphincter muscles back inside, he draws this area back, readjust the muscles & sews it all up.

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As far as I know fixing that part of the stomach that has gone outside its area is called a hiatal hernia operation, is often done at the same time as a fundoplication, but is separate procedure.

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Your post -
> The operation is about as effective as taking 'Pariet'. If Pariet works, generally so will the operation.
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I cannot make sense of this statement. The 2 procedures are unrelated, and the fact that Pariet works would have no bearing on whether or not a fundoplication would work. That depends on the Manometry Test and what the surgeon does. And I now believe that partial fundoplications (which I had) are mostly a waste of time and money.

The keyhole surgery itself is no problem, 2 nights in hospital, and then home.

At the very least, DSM, if you do have the surgery, then have a PH study done before and afterwards, to see if the surgery has made a difference.

Hope you get it all sorted out. An initial endoscopy should tell you the state of your lower esophagal sphincter, but the Manometry tests are all important if you think you might go for the op in order to get off Pariet.

Good luck.

cheers

Mars

Mars,

I am quite sure I won't have the op but the comment re Pariet is what the doc said. "If 'Pariet' medication works then I normally expect the operation to work'".

I interpreted what he said as indicating the operation & Pariet meds are 'take your pick'. If Pariet is doing the job, & all else being equal (tests for the operation stack up) then choose between remaining on Pariet & living comfortably, or have the operation (with its stated levels of success) and drop taking Pariet, and, as he then says, the operation will not feel much different to taking Pariet. 'It becomes a lifestyle choice".

If the case of your own op, did you get any clarity as to why it was not successful ?

Cheers

DSM

Years ago when I worked in a hospital pathology lab the Nissan Fundoplication (not by keyhole) must have been in vogue, because the surgery schedule had several of them most days. One day we received a specimen from a follow-up surgery labeled as a "pessory" and it looked like a baby's teething ring to me - C-shaped and gel filled clear plastic. I was familiar with them being used in bladder prolapse, but the doc said this one had been used for a hiatal hernia repair (unsuccessfully I presume). Hmmm.

DSM, have you already been diagnosed as having a hiatal hernia? If that surgery is for hiatal hernia repair, how would it benefit one whose reflux is due to a weakened sphincter rather than a tear in the diaphragm causing a hernia? Just wondering.

I have what is called a small sliding hiatal hernia - nothing to merit surgery. Remember exactly when it happened. Was standing by the gurney in an ER waiting for a breathing treatment and desperately trying to catch my breath during a prolonged violent coughing attack. (My lungs had been damaged by a toxic chemical spill.) Suddenly I felt the most intense internal searing pain radiating from the sternum area out through the chest and abdomen. Scared, I called for the nurse, and told her something was suddenly very wrong. They had no idea why I felt such pain, and it was later after I found out about the hiatal hernia that had not been present in prior exams that I realized what I had felt was my diaphragm tearing.

The doctor I worked with said surgeries to repair hiatal hernias don't have a good success rate. Some cases could be extreme enough that any possibility of relief is worth trying for.

One such case at the hospital was an elderly woman being admitted for a massive lung tumor. The docs marveled at how she had tolerated a tumor long enough to grow to such size without having any respiratory distress. They only discovered it incidentally on an xray when being checked out for digestive issues. There was debate if such a radical surgery as removing a lung should even be attempted at her advanced age. They decided to proceed in view of her otherwise good health. Got in there and found her entire stomach had slid through a hiatal hernia up into her thoracic cavity, worked its way over the top of her left lung, and was hanging behind it. I'd say the odds of getting a few good years out of that repair seemed like a good deal to her.

Gee. Hadn't thought about that for over 20 years.

Kathy

Kathy

My knowledge on this is very limited & mostly am passing what I have been told. I always have understood GERD on terms of what I have been told which in turn would relate to what they found in my case. Because it is me repeating what I heard it is also subject to 'chinese whispers' (changing meaning as it is passed on).

What I understand is that there are several triggers that can initiate GERD & the doc mentioned sinus problems & post nsal drip as significant factors & this matters to me because of sinus.

He said being overweight is a very significant factor as well & that typically the 'heartburn' is when the acid is pushed out the top of the stomach. He said that when we lay down the stomach is actually sideways across & the opening is lower than the main part of the stomach. The acid ends up damaging the lining outside the sphincter area & when it gets bad that area has been damaged & what he pulls back into the stomach. I gather the sphincter is two muscles that are like very large vocal chords ?.

I had reached a point where any fatty food or beer coffee, alcohol etc: would cause severe heartburn & I would be going through bottles of Gaviscon (like Mylanta). Once on Pariet (started about 6 years ago just before going on xPAP therapy). All the heartburn pain went almost immediately. Pareit (which reduces acid by 90%) is like an on/off switch for me in regard to heartburn.

DSM