|
Specialty Procedures:
Benign Esophageal Procedures
Laparoscopic Fundoplications
Operations to repair a hiatus hernia and reconstruct the valve that sits between the esophagus and the stomach have been present for over 50 years. In the past they have required major incisions either through the chest or the abdomen. Shortly after the introduction of laparoscopic cholecystectomy, European surgeons adapted the older, open procedures to the new laparoscopic technique. As a result, the procedures can now be done using a few small incisions on the abdomen. This leads to a quicker recuperation, less pain and the absence of a large incision. Nevertheless, the risks and complications associated with this surgery are similar to those involved in any type of intestinal surgery, including the need to convert to an open operation, injury to the liver, spleen, esophagus or stomach, bleeding, late infection, increased gas or bloating after the surgery, difficulty belching or vomiting (known as gas bloat), difficulty swallowing, diarrhea and finally, failure of the operation to improve the symptoms.
Nissen Fundoplication
Typically the Nissen fundoplication surgery is done after you have been admitted to the hospital on the day of surgery. General anesthesia is required. During the operation, the surgeon will mobilize the stomach and the esophagus and close the hiatus hernia to make sure that it is tight and firm. The surgeon then determines how floppy or loose the top of the stomach is and whether it can be wrapped around the end of the esophagus without dividing any further vessels. Eventually, the stomach is wrapped around the back of the stomach and sewed to itself creating a collar around the end of the esophagus. As the stomach fills with food and liquid, the pressure inside the stomach increases and is transmitted to the wrapped portion of the stomach, which has a tendency to clamp down or narrow the end of the esophagus. This prevents acid and gastric contents from refluxing into the esophagus.
The surgery takes about 2-3 hours. Most people are awake within several hours after the surgery and stay in the hospital for 24-36 hours. After the surgery the most notable changes will occur with eating in the early postoperative period. During this time you will be asked to stay on a fairly liquid diet for approximately 10 days. This is because the swelling and narrowing around the esophagus is worse immediately after surgery and gradually resolves thereafter.
You will also notice that you have significant gas and bloating and you may also have a fair amount of diarrhea. After 10-12 days you will be allowed to gradually increase your diet.
You will also be asked to continue any antacid medications you have been on. These will be continued for about 10 days to two weeks before being gradually tapered off.
Finally, you will be asked to refrain from doing any heavy lifting (greater than 15 lbs.) for six weeks. Any lifting may increase the intra-abdominal pressure and rupture the sutures that we have placed to wrap the stomach around the esophagus.
Toupet
A variant of the Nissen fundoplication is the Toupet procedure. It differs from the Nissen only in that the end of the esophagus is only partially (270 degrees) wrapped by the fundus. This procedure is used if your doctor believes that there may be some slight disturbance in the ability of your esophagus to push food into the stomach.
Laparoscopic Heller Myotomy
The procedure used to treat achalasia is a Heller Myotomy. This procedure can also be done laparoscopically and it gives excellent long-term results in the management of achalasia. The operation is done under general anesthesia, as is the Nissen fundoplication. The surgeon identifies the junction between the esophagus and the stomach at the diaphragm. The surgeon then cuts the thickened muscle (myotomy) that is responsible for the obstruction. This is done for a distance of 6-8 centimeters and extends from the esophagus onto the stomach. In addition, the surgeon also performs some sort of an anti-reflux procedure, either a Toupet or similar partial wrap in order to minimize the reflux of acid and stomach contents through the newly-opened sphincter.
|
Send Feedback to: 
