Surgery
Surgical procedures to
correct symptoms of
Gastric Reflux and
Hiatus Hernia
Information
You have been told you have some form of reflux
disease or other oesophageal condition. You may have
taken medication in the past to try and rectify this
condition, but your surgeon has recommended that you
have surgery. Any suitable alternative treatment should
have been discussed with you at the time or at your
outpatient appointment. If this was not the case, please
do not hesitate to ask for further information. Your type
of surgery will depend of what condition you with which
you have been diagnosed.
Laparoscopic Fundoplication for Reflux disease
Reflux disease occurs as a consequence of a weak
valve between the oesophagus (the gullet) and the
stomach, which allows excessive backflow of gastric
juices (including acid) into the oesophagus where it
causes local damage and the symptoms associated
with the condition. The surgical treatment for this
disease is called a ‘Fundoplication’. It is performed
either as a laparoscopic (keyhole) or an open
procedure. If it is carried out as keyhole surgery, small
incisions are made in the abdomen that allows entry of
the operating telescope and instruments. It basically
involves fashioning a new valve by utilising muscle and
part of the stomach into a new valve and creating an
effective barrier to reflux.
2
After the operation you can normally go home within 24
hours or the next day or so depending on the
individual’s recovery and ability to eat and drink.
If it is carried out as an open procedure you may need
to stay in hospital for a while longer while you recover.
Symptomatic relief is immediate but you may have short
term swallowing difficulties as the gullet gets used to a
new working valve.
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Laparoscopic surgery for Hiatus Hernia Repair
The conditions of a hiatus hernia and reflux disease are
closely related and therefore surgery is similar. In many
instances of a Hiatus Hernia, the oesophagus itself is
shortened (either congenitally or as a consequence of
reflux disease). This causes it to migrate into the chest
and cause problems.
In the operation, the hernia sac is dissected and
removed, releasing the oesophagus, which if proven to
be short is lengthened. The rest of the procedure is the
same as the Fundoplication. Recovery may take a day
or so longer if a very large hernia was present.
4
Laparoscopic procedure (Hellers Cardiomyotomy)
for Achalasia
Achalasia is an uncommon condition that affects about
6,000 people in Britain. It results from failure of the
valve (the cardia) between the gullet and stomach to
open to allow food to pass through, causing difficulty
and sometimes pain in swallowing their food. Food may
be regurgitated or vomited shortly after meals.
It is caused by damage to the nerves in the gullet wall;
the reason for which is unknown.
Similar incisions to a Fundoplication are made and postoperative recovery is normally over two to three days.
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Until your surgery is arranged the following are
commonly advised:
•
Stop smoking or cut down dramatically. Chemicals from
cigarettes relax the sphincter muscle and make acid reflux
more likely. Symptoms may ease if you stop smoking.
•
Avoid large volume meals, try to ‘graze’ by eating little and
often.
•
Sit and eat food upright accompanied by fizzy drinks.
•
Some food and drinks may make your reflux worse. Let
common sense be your guide and judge for yourself which
food or drink you are taking cause you the most problems.
You could avoid these until your surgery then try to introduce
them back into your diet after your procedure.
•
Some drugs may worsen acid reflux; they may irritate the
oesophagus or relax the sphincter muscle and make acid
reflux more likely. The most common culprits are antiinflammatory painkillers such as Ibuprofen or Aspirin. Tell your
GP if you think a drug is causing the symptoms or making
things worse.
•
Weight: If you are overweight it puts extra pressure on the
stomach and encourages acid reflux. Losing some weight
may ease the symptoms.
•
Posture: Lying down or bending forward a lot during the day
encourages reflux. Sitting hunched or wearing tight belts may
put extra pressure on the stomach, which may make reflux
worse.
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•
Bedtime: Symptoms can sometimes be more troublesome at
night, the following may help:
o Go to bed on an empty, dry stomach. To do this, don’t eat
in the last three hours before bedtime and don’t drink in
the last two.
o If you are able, try raising the head of the bed by 1020cms by placing books or bricks under the bed legs. This
helps gravity to keep acid from refluxing into the
oesophagus.
Dietary guidelines following your procedure
After your procedure, dietary changes are needed for
the following reasons:
•
To prevent food getting stuck or forced through the narrowed
and swollen area between the gullet and the stomach. For
the first few weeks, it is normal for you to find it difficult to
swallow.
•
To prevent the stitches (that were placed during the
procedure) from loosening when the stomach becomes too
full.
•
Patients often feel that they become full very quickly during
mealtimes and that they are not able to bring up wind (burp).
•
It is important to adapt your diet for approximately 4-6 weeks
after the procedure in order to allow the tissue to heal and to
prevent complications.
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Dietary changes for the first 1-2 weeks after the
procedure
Food taken during this period should have a soft, fine
and moist texture and should be served with plenty of
sauce/gravy.
•
Only finely minced meat that has been cooked until soft and
prepared in a sauce/gravy or soft stewed meat may be eaten.
•
Fresh bread, toast, crackers. You may be able to swallow if
you either moisten with spreads/sauces or soaking in soups,
casseroles and drinks.
•
Avoid bread, cakes and biscuits. These foods form small
lumps that are difficult to swallow and can possibly get stuck.
•
Avoid foods that have been deep fried in oil, including
fried eggs.
•
Avoid dried and fibrous fruit and vegetables. All fruit must be
peeled and can be liquidised if needed.
Dietary Changes from approximately 2-6 weeks
You can gradually start introducing more textured foods
into your diet as your swallowing improves.
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The following must still be avoided:
•
Tough chewy food. Chew all food well before swallowing.
•
Roasted and tough meat. Meat must still be soft.
•
Dried fruit (unless stewed) or very hard, fibrous fruits or
vegetables
The following may need to be limited or avoided:
Fresh bread, toast, crackers. You may be able to swallow
them if you moisten them with spreads/sauces or soak
them in soups, casseroles and drinks.
Meat
Meat that has been cooked until tender, soft and served
with a sauce or gravy e.g. stew
Finely minced meat with plenty of sauce/gravy
Steamed, poached or tender fish served with a white
sauce.
Egg
Scrambled, boiled or poached eggs
Baked egg custard
Cheese soufflé
Milk
Suitable food choices
Any dairy products are allowed
Avoid yoghurt with pips or fruit pieces
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Cereals &
bread
Vegetables
Ripe bananas, melon
Soft, tinned or stewed fruit. Peel all fruit and remove pips.
Puree fruit if necessary.
Soft cooked vegetables e.g. carrots, pumpkin, butternut
squash, courgettes, avocado, pureed peas, spinach
misc
Fruit
Cooked porridge
Cereals: any cereal that is soaked with milk
Mashed potato/ sweet potato (without the skin)/ pasta/ rice
Pasta with cheese or white sauce/noodles
Biscuits that have been dunked in tea or coffee
Avoid rich sauces that are very high in fat.
Seeds, pepper, curry and chilli
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General Hints
•
Eat very slowly and chew your food very well before
swallowing. Food that cannot be chewed finely must be
avoided.
•
Eat smaller, more frequent meals instead of large meals.
(Have six small meals instead of three large meals).
•
Drink fluids with your meals taking sips after each mouthful.
Aim for at least 2 litres of fluid per day.
•
Avoid/restrict the intake of gas forming foods if they cause
problems. Gas forming foods include: dried beans, lentils,
peas, soya beans, broccoli, Brussels sprouts, cabbage,
cauliflower, kohl rabi, corn, cucumber, sauerkraut, radishes,
turnips, leeks, onion, shallots, green peppers.
•
Food should have a soft, moist texture. Avoid rough, fatty
food.
•
Fizzy drinks and beer must be avoided if they cause
discomfort.
•
Avoid rich sauces that are very high in fat and seeds, pepper,
curry and chilli.
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You will probably be able to get back to your normal
activities within a short amount of time. These include
showering, driving, walking, lifting (light objects), work
and sexual intercourse. Depending on your job you
could be back at work and driving within 2 weeks of
your operation, though complete recovery may take
several months.
Upon discharge you will be given a follow up
appointment. This is to make sure that you are feeling
well, the wounds are healing and that you are managing
to take sufficient diet and fluids. If you have prolonged
soreness, continue to have problems eating and
drinking and are getting no relief from the prescribed
pain medication, you should contact your GP or the
Specialist Practitioner.
Contact Information
Surgical Practitioner
01536 493318 Office
01536 492000 and ask for bleep 669
(Between 8am and 4pm Mon to Fri)
Out of GP hours
Nenedoc – 03336 664664
For severe difficulties: go to Accident and Emergency direct
If you need this information in another format or language,
please telephone 01536 492510.
Further information about the Trust is available on the
following websites:
KGH - www.kgh.nhs.uk | NHS Choices - www.nhs.uk
Ref. PI 658 December 2012
Review: September 2014