As has been discussed under the section on reflux disease, heartburn and reflux is very common from time to time. The majority of people will experience a little bit of reflux from time to time and even those who have frequent reflux usually have their symptoms controlled with simple dietary measures and/or regular medication. A small number of people will continue to have symptoms despite maximal medical treatment or may have symptoms that are not suitable for control with medical treatment, or may not wish to take tablets on a long term basis. These people may be candidates for a laparoscopic fundoplication.
The aim of anti-reflux surgery is to restore normal anatomy, for example, ensuring you have a portion of your oesophagus below the diaphragm and also to reinforce the natural valve at the end of the oesophagus. This valve is reinforced by wrapping part of the stomach around the oesophagus. There are various different ways of doing this; these operations are known as the Nissen, the Toupet, or the anterior fundoplication. All of these operations have been shown to work well and produce good long term results. The type of operation used is usually down to surgeon preference.
Prior to surgery, patients require appropriate investigation and this will include an endoscopy, pH studies and also possibly a barium swallow. This is because it is important to establish that your symptoms are caused by reflux. There is nothing worse than having an operation and being no better.
With anti-reflux surgery, you are exchanging one set of symptoms, for example, heartburn or volume reflux symptoms such as coughing, choking or asthma type symptoms, for post-surgical symptoms such as a feeling of bloating and excessive flatulence. With anti-reflux surgery, you are exchanging a valve at the bottom of the oesophagus that can relax and tighten, for a fixed valve which does not relax and tighten.
This fixed valve has to be tight enough to stop your reflux otherwise you will get no benefit from your surgery. In return, you can experience difficulty in being able to vomit. Also, we all swallow some air as we eat, and usually get rid of this air by burping. After a fundoplication this can be difficult so the air has to escape in other ways and ultimately will end up coming out the other end as flatulence.
Therefore when deciding if anti-reflux surgery is appropriate for you, you have to decide whether your quality of life with reflux is such that you would prefer to live with these other operation dependent lifestyle issues. Nevertheless I have to say that the vast majority of my patients who proceed with anti-reflux surgery have not expressed any regrets. It is not reversible and in addition, there is limited long-term data weight loss data beyond seven years.
Specific risks related to the laparoscopic sleeve gastrectomy include a staple line leak. The stomach is divided and closed with a stapling device. The staple line has to heal and there is a small risk that it could leak. If this was to happen, you would require further surgery, usually laparoscopic, and possibly a stay in intensive care. If the leak is not controlled and infection results, this can become life threatening. In addition, the staple line can bleed.
This is usually managed without the need for a return to surgery and occurs in less than 1% of cases. Less common complications are impairment of the stomach’s ability to empty and stricturing or narrowing of the stomach tube. These complications occur in less than 1% of cases.