Putting out the fire of acid reflux

09 July 2018

The annoying and sometimes painful feeling you get following a delicious dinner may need more than a simple indigestion tablet.

Anti-reflux surgery is a treatment for acid reflux; it may be something you haven’t considered before, but to beat the daily difficulties such as remembering to take ant-acid medication and getting that prescription before going on holiday, as well as the embarrassment of acid reflux it’s something worth looking into. Just imagine how it used to be…. eating what you like, whenever you like and not having to take a pill to stop acid.

At Spire Parkway Private Hospital, Solihull, Birmingham West Midlands, Consultant General Surgeon Mr Paul Super offers transabdominal anti-reflux surgery (fundoplication as it is medically known).

Here Mr Super answers some questions about anti-reflux surgery.

Q: What is acid reflux?

A: Acid reflux, also known as GORD (gastroesophageal reflux disease), is a condition in which food or stomach acid comes back up into the oesophagus (the tube from your mouth to the stomach). This is caused by a lax sphincter muscle at the bottom of the oesophagus where the food first enters the stomach.

Q: What are the symptoms?

A: Symptoms can include a bitter taste in the mouth, a burning sensation in the throat or chest (heartburn), feeling gassy and burping or it may leave you finding it hard to swallow. It can contribute to hoarseness, chronic cough, asthma and for many it is the most common reason for chronic indigestion.

Q: Can diet and lifestyle changes improve reflux?

A: Improving your diet may help improve the symptoms of reflux; coffee, alcohol, chocolate, fatty or spicy foods and large meals can aggravate acid reflux, as well as being overweight and being a smoker. It is worth improving these areas generally for overall better health, but it is not guaranteed to resolve the issue of acid reflux, especially if there are other issues such as a hiatus hernia adding to the problem.

Q: What is a hiatus hernia?

A hiatus is the name for an opening in the diaphragm. Normally the oesophagus goes through the hiatus to attach to the stomach.

A hiatus hernia is when the stomach bulges through the opening into the chest area. This means that your stomach sits higher than normal, thus allowing acid to easily leak into the oesophagus. 

Q: What is transabdominal anti-reflux operation (fundoplication)?

A: When surgery is required for acid reflux, one of the most common procedures is called fundoplication. This is a day case procedure performed under general anaesthetic.

If a hiatus hernia is present, it is repaired by stitching the hiatus (opening in the diaphragm) to make the hole for the food pipe smaller.

Q: How long does the surgery take?

A: It takes around 40 minutes to repair a hiatus hernia and perform the fundoplication, depending on how large the hiatus hernia is.

Q: How does the surgery work?

A: There are two parts to the operation; repairing the hiatus hernia and performing the fundoplication.

Hiatus hernia repair means that the stomach is placed back into the abdomen and the hole in the diaphragm (hiatus) is stitched to a smaller size. The fundoplication part of the operation means that the loose sphincter area of the oesophagus is compressed gently using the top of the stomach which is partially wrapped around the lower oesophagus to keep the valve closed most of the time – except for during swallowing when it is pushed open as the food is going down.

Q: What are the benefits?

A: No more pills, no indigestion and heartburn. In addition, for many patients their respiratory and ENT type symptoms of cough, asthma, sore throat and hoarseness may be better. The benefits are long lasting with recurrence rates of reflux around 1-2% at 5 years.

Q: Are there any side effects?

A: The usual side effects are weight loss for about 1 month (usually about 3-5Kg) due to having stomach surgery. Following surgery, burping may be difficult meaning more wind goes through your bowel if you swallow lots of air at mealtimes (eating quick, not chewing, talking a lot etc). Approximately 1 in 200 patients have difficulty in swallowing meat and bread which persist after 3 months in which case a balloon dilatation in X-Ray may be required to loosen the lower area of repair if it has healed up too tight.

Q: What happens after the procedure?

A: Patients can return home the same day with a follow up appointment arranged to see your consultant for a post-op check-up at about four weeks. You will need between one and two weeks off work.

Q: How quickly could I have a consultation, and how much would it cost? 

A: It depends on the availability of the consultant you wanted to see, but we pride ourselves on getting you fast access to diagnosis and you can often get a consultation within 24/48 hours. Initial consultation fees vary by consultant, but around £175 is a reasonable guide.

Q: If I need surgery, how quickly could I have it?

A: We have no waiting lists at Spire Parkway, but again it depends on the availability of the consultant you wanted, but as a guide, and subject to your pre-operation assessment, between one and two weeks. Your specialist may require further tests such as oesophageal manometry where the defective sphincter pressures are measured to confirm the diagnosis, but this usually only takes a week to arrange. Thereafter surgery can take place as quickly as one week after this test.

Q: I don’t have health insurance, can I self-pay? 

A: Yes, you can. Our self-pay team can talk you through this and explain the finance options that are available, should you wish to explore them. Call 0121 704 5530, or click here to submit an enquiry online.

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