STOMACH HERNIA AND GASTROESOPHAGIAL REFLUX DISEASE

Normally, the direction of movement of food in the digestive system is from the mouth to the esophagus, to the stomach, and then to the intestines. Reflux is when the stomach contents escape backwards, that is, into the esophagus, without any force.

What are the symptoms?

Burning and sourness rising from your stomach to your chest

If bitter-sour water comes to your mouth from what you eat,

If you have hoarseness, pharyngitis, laryngitis,

If you have a cough - treatment-resistant asthma.

What are the causes of reflux and hiatal hernia?

There may be many reasons for the formation of the disease. Sometimes the muscles that act as valves between the stomach and the esophagus can relax and open without any reason. Afterwards, complaints occur due to stomach contents leaking into the esophagus. There are many other factors that cause reflux.

Whatever the reason, the main problem here consists of stomach acid passing into the wrong environment

and destroying the cells there. Contrary to popular belief, the amount of acid in the stomach

is not at high levels. The amount of acid is normal, but its location is wrong.

How common is it?

Studies have found that the incidence of the disease in our country is the same as in the United States or European

countries. It should be taken into consideration that we are faced with a disease that affects 20% of adults.

In fact, reflux is not a new disease. On the one hand, it has become more prominent in recent years with the intense interest of mass media. On the other hand, significant developments have been experienced in both diagnosis and treatment during this period. It was later understood that many patients who had been diagnosed with gastritis in the past actually had reflux disease.

What are the complaints in reflux disease?

Typical complaints are a burning sensation behind the breastbone and mouth. It is the coming of bitter and sour water. Some

patients have unusual complaints. We call these atypical complaints.

Patients experience chest pain, throat, lung and dental problems (hoarseness, frequent throat clearing), which can even be confused with a heart attack. feeling, polyps in the vocal cords, cough, asthma-like complaints)

might be encountered.

The disease can occur in different forms. We mostly encounter it in what we call “non-erosive” form

. In this common type, despite intense complaints, no visible damage to the esophagus can be detected in endoscopic examinations. In such a case, we may resort to diagnostic methods other than endoscopy.

In the "erosive" type, visible wounds (ulcers) occur in the esophagus. This

condition needs to be treated immediately. Otherwise, more serious problems may be encountered.

In "Barrett", a third type of reflux disease, cells exposed to acid in the esophagus are seen to have changed shape. Cells leaving their original shape and taking on a different state (i.e. Barrett's development) is an undesirable situation and may indicate an increased risk of developing cancer in the esophagus.

>Diagnosis: One of the most important points in diagnosis is the detailed examination of the patient's complaints by the physician

. Because there are different diseases that can be confused with reflux, the patient may also have a second digestive system problem in addition to reflux. In the following stages, endoscopic examination is essential

The diagnosis is made by endoscopy, if necessary, the diagnosis can be made by applying one or more of the specialized tests such as pH-metry, BRAVO capsule pH-metry, impedance, manometry

.

What is the treatment of reflux disease?

There are different options for the treatment of reflux disease, ranging from social measures to surgical intervention.

· Social measures: Elevating the head of the bed, avoiding foods and beverages known to be refluxogenic (orange juice, pizza, cola drinks, etc.), not choosing too tight clothing. Many social measures can generally be effective in patients with mild reflux.

· The second option is drug therapy. In short, drugs known as PPI (proton pump inhibitors) strongly reduce acid secretion, thus eliminating complaints. They cause n to disappear. However, drug

treatment often requires constant use. Discontinuation of the drug causes the symptoms to reoccur and cause the disease to relapse. This is due to the fact that drugs can suppress acid secretion only on the days they are used. In other words, drug therapy is not a definitive treatment

method, but a type of treatment

that eliminates the patient's complaints only on the days it is used.

· Intervention models known as endoscopic treatments are It has not been able to gain a solid place for itself in either Europe or America

continent. Because their effectiveness in treatment has not yet reached a satisfactory level

.

· The definitive treatment for reflux is laparoscopic reflux surgery. Of course, what is desired is to perform this intervention

with laparoscopic method, that is, closed surgery. With laparoscopic surgery, the upper part of the stomach is wrapped around the lower end of the esophagus and sutured, thus preventing reflux. Patients can be discharged one day after the operation, which takes approximately 45-60 minutes. While patients' need for medication disappears after reflux surgery, there is a diet period that must be followed for about 1-1.5 months. After surgery patients complete the diet period, it is possible to consume the foods and beverages they avoided during the pre-operative period.

Laparoscopic Surgical Interventions:

It is performed under general anesthesia.

Four intervention sites are used on the abdominal wall.

A camera is placed at the entry point number 1, and other surgical instruments are placed at the intervention site numbered 2, 3, 4 and 5

is used.

If there is a stomach hernia (that is, a part of the stomach is inside the rib cage), the hernia

repair is first performed and the procedure begins.

In some cases (for example, if the hiatal hernia is very large), it may be necessary to support the hernia repair with a synthetic patch

The flexible upper part of the stomach, the lower part of the esophagus, to treat the reflux

> It is wrapped around the

part in the direction of the arrow. In this way, an area that acts as a cover is created and

The section is stitched together all around and the procedure is completed.

Laparoscopic Surgery and Aftermath:

Operation time is approximately 45 - 60 minutes.

Patients are discharged the day following the operation.

They can return to their normal activities and work within 3 - 5 days.

There is a diet period that lasts 2 - 3 weeks.

There may be complaints of gas and bloating due to the surgery.

Patients are advised not to lift very high weights in the post-operative period.

The comfort and success of laparoscopic surgery increases the rate of patients' acceptance of surgical treatment

It has increased.

Patient satisfaction is at the level of 95%.

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