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Commonly Asked Questions & Answers on Videoscopic Surgery for Relief of Chronic Heartburn due to Gastroesophageal Reflux Disease:
Q. What is a videoscopic surgical procedure?
A. A videoscopic surgical procedure, such as a laparoscopic cholecystectomy, is a less invasive alternative to the traditional or "open" surgery. During a videoscopic procedure, a laparoscope, video camera, and light source are passed through a specially designed tube into the body to improve visualization while surgery is performed through several small incisions.
Unlike the long incisions (4-6 inches) required in traditional surgery, videoscopic surgical incisions may be less than an inch long. They are typically closed with a few stitches. Smaller incisions result in faster recovery and potentially less pain.
Q. What is the videoscopic Nissen fundoplication procedure?
A. This procedure is designed to improve the natural barrier between the stomach and the esophagus. The surgeon wraps the gastric fundus around the lower esophagus to prevent the flow of acids from the stomach into the esophagus.
Q. Which patients are ideal candidates for the videoscopic Nissen fundoplication procedure?
A. Most patients are not candidates for videoscopic surgery. However, videoscopic surgery is an option for selected patients with severe chronic heartburn that still disrupts their lives, despite lifestyle modifications and appropriate medication. Other heartburn sufferers who may benefit from videoscopic surgery include younger patients (<50 years of age) facing a lifetime of medications, patients who find medications a financial burden, patients who are non compliant with their drug regimen, and patients who prefer a single intervention to long-term therapy. Diagnostic testing is critical for all patients to document the disease and determine whether surgery is an appropriate option.
Q. How successful is the surgery?
A. Studies show that over 90 percent of patients are symptom-free after a videoscopic surgical procedure to correct gastroesophogeal reflux disease. "The quality-of-life assessment has been the most dramatically improved outcome variable..." in patients studied.
Q. What are the risks involved?
A. As with any surgery, there are risks associated with videoscopic surgical procedures. Complications tend to be minor and arise, on average, in 10 to 15 percent of patients.
Q. Are there any side effects after the surgery?
A. Generally, side effects subside 4 weeks post operatively and may include dysphasia, gas and bloating, belching, vomiting, nausea and/or diarrhea. Early satiety and increased flatus have been the most common side effects noted. When compared with preoperative symptoms, 97 percent of the patients surveyed reported overall satisfaction.
Q. What is the process for referring a patient for surgery?
A. Before surgery, a diagnostic evaluation must be made to ensure that gastroesophageal reflux is the underlying cause of the patient's symptoms. This is most commonly done with 24-hour esophageal pH monitoring. Esophageal contactility is then assessed via monometry to insure that the esophagus has sufficient power to function with a newly reconstructed valve. Finally, esophageal length is assessed using contrast studied and endoscopy to ensure adequate ability to perform when shortened. Based on these test results, physicians can determine appropriate treatment and if a patient is a candidate for surgery.
Q. What can a patient expect following surgery?
A. After videoscopic surgery, patients can expect some pain in their abdomen where the small incisions were made. This usually disappears within 24 to 48 hours. Occasionally, patients will regurgitate what they swallow, but that is related to the dysphasia that is common post operatively, and it should go away within 4 weeks.
Patients are usually allowed liquids immediately after surgery, but they should not overdo it during the first 12 hours. They will be given soft solid food the following morning. A soft diet should be continued with no bread or red meat until their first postoperative office visit.
In a prospective evaluation of 100 patients with "typical" symptoms, hospital stay averaged 3.1 plus or minus 0.2 days.
Q. How can I identify surgeons experienced in the Nissen fundoplication procedure?
A. Contact local surgeons and ask:
- If they perform videoscopic surgery and, specifically, anti reflux procedures.
- How many procedures they have performed.
- What their patient outcomes have been.
- The length of patient recovery period.
You can also ask what other physicians have recently referred patients to them.
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