Acid Reflux, as known as Heartburn or Gastro-oesophageal reflux (GORD) is a very common condition which affects up to 15-20% if adults once a week. Patients will often describe symptoms of:
- Burning and discomfort behind the breastbone
- The unpleasant taste of gastric acid or bile at the back of the mouth
- Vomiting/Choking when lying flat
- The feeling of food getting stuck when swallowing
- Chronic cough
Acid Reflux has many causes and is not simply as a result of having too much stomach acid. Some risk factors in developing Acid Reflux include:
- Surgery such as Laparoscopic Gastric Banding and Gastric Sleeve
- Certain foods such as spicy foods, alcohol, fizzy drinks
- Some disease and Medications
Fortunately, most acid reflux is mild and short-lived. Many patients find improvement by modifying some of the causes listed above including avoiding certain foods and weight loss.
There are several Anti-Acid Medications also available. These range from milder non-prescription medications to high strength formulations that do require a prescription.
In some cases, if severe acid reflux is not adequately treated it may cause serious damage to the oesophagus over time which can be a risk factor in developing cancer of the oesophagus. To assess this Dr Andrew Kiyingi may recommend performing a Gastroscopy.
In some patients Acid Reflux is caused by a separation or weakening in the muscles at the top of the stomach that normally acts as a control valve to prevent reflux. When this weakening or separation occurs part of the stomach can protrude upward through the gap into the chest cavity and this is known as a Hiatus Hernia.
Most hiatus hernias are small and do not require any management as they do not cause any symptoms. However moderate to large hiatus hernias can cause severe or frequent Acid Reflux symptoms. Even with a Hiatus Hernia many patients find improvement in their reflux by reduced risk factors for reflux such as avoiding certain foods and weight loss. Anti-acid medications are also very effective in improving symptoms.
A few people with a hiatal hernia may need surgery. This is usually considered only when medications and lifestyle changes fail to relieve severe reflux symptoms, or if you have a large hiatal hernias that is likely to lead to future problems or complications if left untreated. If you having a weight loss surgery and also require a hiatus hernia repair, Dr Andrew Kiyingi can often performed both of these operations at the same time through the same key-hole incisions.
Prior to the surgery Dr. Andrew Kiyingi may organise some investigations which may include a Gastroscopy, blood tests, Xray Swallow test or even CT scan to prepare for surgery. As the procedure is performed under general anaesthesia, you will be reviewed by an anaesthetic doctor and will need to fast for a minimum of 6hrs prior. No oral intake or chewing gum. Please advise us before surgery if you
Have any allergies
Are on blood-thinning or any non-prescription medications.
During the procedure 4 – 5 small incisions (<2cm) will be made on your abdomen. Carbon dioxide gas will be used to expand your abdomen, allowing the organs to be seen. A special narrow camera called laparoscope, will be inserted through one incision and a video image will be relayed to a tv screen to allow the surgical team to perform the surgery. Further small instruments will be inserted through the other incisions.
An operation for a hiatal hernia involves pulling your stomach back down from the chest cavity (where it should not be) into its correct position in the abdomen and also repairing or reconstructing the weak muscle separation at the top of the stomach that caused the problem. In some cases if the muscles are very weak Dr. Andrew Kiyingi may need to strengthen them by placing a bio-absorbable mesh over them. At the end of the procedure, the incisions are closed with dissolving sutures and covered with a waterproof dressing. The operation will be complete when you wake up and you will stay in the recovery unit for some time till you are ready to return to the surgical ward. It is common to have mild swallowing difficulty during the first few days after surgery. You will also be provided with special dietary information during the early recovery period as the swelling settles.
Laparoscopic Hiatus Hernia Repair is a moderate risk procedure and similar to all surgery, complications can still occur. Some Complications include:
General Anaesthesia Complications particularly relating to maintaining your breathing, heart function, and circulation.
Damage to surrounding organs such as the lungs, oesophagus, and nerves
Even with a good repair, there is a risk that the hiatus hernia may recur if the muscles remain weak
Even with a good repair, there is a risk that some reflux may persist
Blood loss requiring re-operation or blood transfusion
DVT (blood clot in the deep leg veins)
Shoulder / Wound Pain – this is temporary for the first few days.
Hernias from the wounds <1%
Converting the operation from keyhole to Open Surgery if the case becomes complex. This involves a much bigger incision.