Gastro-oesophageal reflux disease and Laparoscopic antireflux surgery

As many as 40 % of the population experience gastro-oesophageal reflux at some time. In the vast majority of people these symptoms settle with over the counter medication or a course of acid suppression.

The typical symptoms are heartburn, regurgitation and sometimes difficulty in swallowing. Reflux can also affect the voice by involving the vocal cords.

Many people with reflux also have a hiatus hernia. This is when there is a weakness in the opening in the diaphragm between the chest and the abdominal cavities and a portion (often no more than several centimetres) of the stomach slips or ‘herniates’ up into the chest. Many patients with hiatus hernia have no symptoms and similarly you can have reflux disease without a hiatus hernia – it is just that they are commonly associated.

Surgery is reserved for the following cases:

When medication does not control troublesome symptoms of reflux disease.

In those who are dependent on long term medication for relief of symptoms and who wish to stop taking acid suppression

In those experiencing the consequences of reflux such as hoarse voice, recurrent chest infections and other sequelae of aspiration.

Preparation for the procedure

An endoscopy is almost always required before any surgery in order to directly visualise the lining of the oesophagus and stomach. This procedure takes several minutes and is usually done under mild sedation.

Many patients also require a 24 hour acid or pH test and a manometry where pressures in the oesophagus are measured.