WHAT IS THE ANATOMY OF THE STOMACH AND ESOPHAPILE?
The esophagus is an organ with a special muscular structure that connects the mouth and the stomach, where digestion begins, and transmits the food we eat and the secretion from the mouth to the stomach. It is approximately 36-38 cm long from the incisors in women and 38-40 cm in men, although it varies with the height of the person. Where it meets the stomach and passes through the natural opening in the diaphragm called Hiatus, there is the lower esophageal sphincter, which is approximately 2 cm long and has a special structure of muscles. Thanks to this structure, stomach contents do not escape into the esophagus outside certain limits.
WHAT IS REFLUX?
Gastroesophageal reflux disease, also known as reflux, is the emergence of stomach contents (acid, bile, food and stomach enzymes) into the esophagus above physiological limits, resulting in symptomatic and endoscopic findings.
HOW DOES REFLUX OCCUR?
The most common cause of reflux, in 70% of cases, is the insufficiency of the part (sphincter) at the lower end of the esophagus, where the esophageal muscles gain a special structure, commonly called the valve. Reflux occurs in cases that exceed the structure and pressure of the sphincter.
WHAT ARE THE CAUSES OF REFLUX?
The most common cause of reflux is structural lower esophageal sphincter insufficiency. Apart from this, the following reasons also cause reflux. Hiatal hernia Obesity Smoking Alcohol Pregnancy Overeating Tight clothing that covers the abdominal area Tea and coffee consumption Fatty and fried foods Desserts Sour foods Acidic drinks Medications (painkillers, osteoporosis, asthma medications)
HOW TO DIAGNOSE REFLUX ?
The most basic diagnostic tool is endoscopy. With endoscopy, stomach hernia, esophagus damage (esophagitis), and Barrett's esophagus can be easily detected. Sometimes endoscopy Patients with normal pH should undergo a test called 24-hour pH monitoring.
WHAT IS PH MONITORING?
After the endoscopic examination, a thin catheter is placed from the patient's nose to the lower end of the esophagus and the catheter is connected to a device the size of a Walkman for 24 hours while the patient is lying down or standing, eating or fasting, during the day or while sleeping. It records the pH changes in the lower end of the esophagus. No special diet is given before and after the procedure; The patient continues living the same way as before. If any stomach medication is used 3 days before the procedure, it is stopped. At the end of 24 hours, the data collected is analyzed on the computer and a score is reached. If this score is over 18, a decision is made for reflux surgery.
WHAT DOES REFLUX CAUSE?
Long-lasting reflux disease causes varying degrees of inflammation (esophagitis), ulceration, stenosis (stricture) in the esophagus due to the damage caused to the lower end of the esophagus, BARRET esophagus and progressive esophagus due to the changing esophageal cell structure. It can also cause lower esophageal cancer in certain periods. Laryngitis Tooth enamel damage Asthma Chronic cough Bronchitis
DOES REFLUX DISEASE CAUSE CANCER?
Due to long-term reflux disease, the cells forming the esophageal mucosa at the lower end of the esophagus may differentiate and lead to metaplasia, then dysplasia and cancer.
WHAT ARE THE WAYS TO PREVENT REFLUX? ?
Lie on a high pillow (the upper body and head should be high while lying down). Avoid eating large amounts (overeating increases stomach pressure and increases the possibility of reflux). Eat small, frequent and regular meals. Eat your food slowly and chew it well. Reduce fat (Fries, fast food and margarine) angle. Excessively fatty foods also have a longer residence time in the stomach and more stomach acid is released). Avoid chocolate (The substance called methylxanthine found in chocolate relaxes the muscles in the esophagus, causing relaxation in the esophagus). Avoid coffee and consume less tea (caffeinated or decaffeinated coffee increases the possibility of reflux). Avoid substances that irritate the esophagus. Do not drink alcohol, acidic drinks such as cola, soda, or canned fruit juices. Avoid very spicy foods, pickles and vinegar (Spices can increase the severity of reflux and increase burning in the stomach. Therefore, limit spicy ready-made foods and use less spices in your meals. Do not lie down immediately after the meal, sit for at least 1 hour. Avoid alcohol (Alcohol increases stomach acid). Smoking and Avoid other tobacco products (Nicotine relaxes the sphincter in the lower part of the esophagus). Do not gain weight (Obesity increases reflux complaints). Try to stay away from stress as much as possible. Drink liquids between meals, not during meals, as it increases stomach pressure. Do not wear tight clothes, especially after meals. Try to wear more comfortable clothes.
HOW IS REFLUX SURGICAL TREATMENT?
Reflux surgery was first performed by Prof. Dr. Rudolf Nissen from Germany in 1936. He started with the surgery he performed on a 28-year-old patient at Istanbul University Faculty of Medicine and is still the gold standard of reflux surgery. Reflux surgery; It is based on the principle of closing the gap in the hiatus, if any, and wrapping the part of the stomach, called fundus, like a sleeve at the lower end of the esophagus, allowing it to escape into the rib cage and creating an artificial sphincter. The procedure is performed laparoscopically (closed) under general anesthesia, through 0.5 and 1 cm holes entered from the abdomen. It is done with special tools.
WHAT SHOULD I DO BEFORE REFLUX SURGERY?
Anesthesia: You will need to be seen by an anesthesiologist at least 48 hours before the surgery. You must inform the anesthesiologist about the medications you regularly use, your chronic diseases, and any surgeries you have had. The anesthesiologist may ask you for some tests before surgery. Therefore, you should come on an empty stomach. Blood-thinning medications: If the patient uses blood-thinning medications, the risk of bleeding will be high when undergoing surgery under the influence of these medications. Such patients need to stop their medications, wait 7-10 days for the effects of the medications to wear off, and then undergo surgery. In some cases, these medications may be discontinued and replaced with medications that do not affect bleeding but prevent clotting during surgery under the skin of the arm. Fasting: The patient should fast the night before the surgery, not eating or drinking anything by mouth, including water, after 24:00, and come to the surgery as if he or she is fasting. However, patients whose surgery is planned in the afternoon can have a light breakfast early in the morning, fasting 8 hours before the surgery. My medications: Patients with diseases such as diabetes, high blood pressure and asthma should be consulted by the relevant branches, risks should be determined and recommendations should be taken. If patients are taking medications related to these diseases, they should take their medications with a sip of water, except for oral diabetes medications, even though they are fasting on the morning of the surgery.
HOW LONG WILL MY LAPAROSCOPIC REFLUX SURGERY LAST AND HOW LONG WILL I STAY IN THE HOSPITAL?
When everything goes well, your surgery will take approximately 1-1.5 hours. However, considering the preoperative anesthesia preparation, sleeping-waking, and postoperative follow-up time in the waiting room, approximately 2 hours are spent in the operating room. You can stay with. After the surgery, patients stay in the hospital for 1 night.
WHO SHOULD REFLUX SURGERY BE APPLIED?
Patients who do not respond to medical treatment. Progression of the disease under medical treatment and the need for continuous increase in drug dosage. Patients who require long-term aggressive drug treatment. Patients who do not want long-term and aggressive drug treatment due to reasons such as cost, discomfort of use or fear of side effects. Patients who do not comply with medical treatment. Patients with a high risk of developing complications in the long term (patients with Grade 3-4 esophagitis). Patients with 1-2 esophagitis but defective CES Patients with sliding hernia resistant to medical treatment Patients with serious complications despite medical treatment Hard hat esophagus, serious pulmonary symptoms
WHAT AWAITS ME AFTER THE SURGERY UNTIL I AM DISCHARGED?
Will the catheter be inserted?
There is no need to insert a catheter in such short surgeries.
Will I have any pain?
As in every surgery. Pain is also felt after reflux surgery. However, after reflux surgery, the pain of the tension created on the abdominal wall by the air given to inflate the abdomen during the surgery is felt rather than the pain of the 5-10 mm wounds in the abdomen. While this pain resembles the tension pain in the abdomen during pregnancy on the first day, on the second and third days, pain similar to the pain in the abdomen occurs after sit-up exercise. None of these pains disrupt daily activity and sleep comfort. These pains will be stopped with a painkiller injection on the first evening and a painkiller paracetemol type tablet on the second and third day.
When will I eat?
6 hours after the surgery, you will be given liquid drinks that do not cause gas, such as water or tea. First time after laparoscopic reflux surgery Liquid and soft foods are recommended for two weeks. After the second week, normal food can be started.
When will I stand up?
You will be able to walk normally 4 hours after the surgery.
In what position can I sleep the night of my surgery?
After surgery, it is recommended that you sleep on your back with your head 30 degrees elevated. However, in order to avoid back pain due to lying in the same position all the time, the position can be changed by turning left and right.
WHAT KIND OF SURGERY WOUNDS WILL BE WHERE ON MY BODY DURING LAPAROSCOPIC REFLUX SURGERY?
If laparoscopic reflux surgery is performed through 4 holes, there will be four surgical scars, three of which are 10 mm and one is 5 mm. In open surgeries performed for any reason, there will be an approximately 20-25 cm surgical scar in the middle of the abdomen extending towards the navel.
Will a prescription be given during discharge? WHICH MEDICATIONS SHOULD I USE, FOR HOW LONG AND HOW?
If laparoscopic reflux surgery is performed through 4 holes, there will be four surgical scars, three of which are 10 mm and one is 5 mm. In open surgeries performed for any reason, there will be an approximately 20-25 cm surgical scar in the middle of the abdomen extending towards the navel.
THINGS I NEED TO KNOW AFTER LAPAROSCOPIC REFLUX SURGERY
Dressing: There is no need for dressing unless specifically stated by your doctor. Are there any stitches to be removed? Since hidden (aesthetic) and dissolvable stitches are used for the incision areas, there is no need to remove the stitches.
Shower-bath: On the third day after laparoscopic surgery, the dressings can be removed and the wound areas can be showered without rubbing. There is no need to cover the dressing again. Sexual life: L Sexual life is not recommended for two weeks after laparoscopic reflux surgery.
Fasting: Fasting is not recommended for the first 6 months after laparoscopic reflux surgery. At the end of this period, if you do not have any other health problems that prevent you from fasting and your doctor does not see any problems, you can fast. Driving: You can drive from the third day after laparoscopic reflux surgery.
Alcohol: Alcohol affects the liver.
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