GERD Operation Cost in India

What is GERD?

GERD, also known as Gastro-Esophageal Reflux Disease or Acid Reflux Disorder, refers to the condition characterized by the backflow (reflux) of the stomach content like stomach acid and bile into the oesophagus. The oesophagus is the hollow, muscular organ that carries food and liquids from the throat to the stomach.

Normally, during digestion process, the lower esophageal sphincter (LES) present at the junction of oesophagus and stomach opens to let the food pass into the stomach and closes to block the backflow of the food and stomach acidic juices into the oesophagus. However, in the case of GERD, the reflux occurs due to weak LES or if it works or relaxes in an inappropriate way.

GERD results in esophageal inflammation and thereby an increase of ulcers, narrowing of esophageal stricture or oesophageal cancer.

GERD is always associated with chronic heartburn which is the most common symptom of GERD. Acid regurgitation, which is reflux of gastric acid into the mouth, is the other common symptom. Other less common symptoms are:

• Pain and difficulty in swallowing
• Dysphagia is the abnormal sensation of food being stuck in the oesophagus.
• Chronic sore throat
• Excessive saliva production.
• Inflammation of larynx, gums etc.
• Bad breath
• Tooth enamel erosion.

Causes:

The factors that are responsible for causing GERD are;

• Abnormalities in LES.
• Abnormal contractions of esophagus
• Prolonged time in stomach emptying
• Hiatal hernias
• Dietary foods like coffee, fatty foods, chocolates, alcoholic beverages can trigger reflux.
• Obesity and pregnancy also contribute to procuring GERD symptoms.

Nissen Fundoplication

The 'gold-standard' therapy for treating gastroesophageal reflux disease (GERD) in those who don't respond to drugs or can't take them for other reasons is the Laparoscopic Nissen fundoplication. The top section of the stomach is wrapped around the lower esophageal sphincter (LES) during the Nissen fundoplication to tighten the sphincter, reduce acid reflux, and repair a hiatal hernia. After surgery, most people find a considerable reduction in acid reflux symptoms.

Gastroesophageal reflux disease (GERD) is a digestive system illness affecting the esophagus. If you have GERD, your stomach acid and contents flow back up into your esophagus on a regular basis.

In individuals with GERD, fundoplication basically fixes the valve at the end of the esophagus that isn't working properly. Unlike GERD drugs, surgery prevents all reflux, including digestive enzymes and acid. As a result, unlike drugs, surgery can cure GERD.

The procedure is named after Dr Rudolf Nissen (1896-1981), who described the first fundoplication in the 1950s for treatment of severe reflux esophagitis.

Nissen fundoplication procedure is usually performed laparoscopically. Laparoscopic operations are carried out through small incisions while the physician observes the procedure on a video display. The fundus (the top of the stomach, thus the term fundoplication) is wrapped around the bottom of the esophagus during surgery. A 'wrap' is another word for a fundoplication.

A completed Nissen fundoplication
By Dana Hamers - Own work, CC BY-SA 3.0,
https://commons.wikimedia.org/w/index.php?curid=20453728

What are different Treatment Options for GERD?

Following enlisted are the treatment options for treating GERD and acid reflux;

1. Lifestyle modification:

   These include alteration in sleeping habits. Patients are recommended to sleep at night with slightly elevating your upper body as patients experiencing heartburn might have reflux at night. This position is of benefit to avoid the reflux at night.

2. Dietary modification:

   Encourage smaller and earlier meals in the evening as it results in lesser expansion of the stomach that may reduce the reflux. Some foods and beverages like chocolates, caffeinated drinks, alcoholic beverages, peppermint etc. are responsible for promoting the reflux, and thus should be avoided. Consumption of fatty foods should be reduced. Smoking should be stopped. Spicy and foods containing acids like carbonated beverages, tomato or citrus juice should be avoided.

3. Medications:

   Following drugs are recommended to lessen the symptoms:

   • Antacids
   • Foam barriers
   • Proton pump inhibitors
   • Histamine antagonists
   • Promotility drugs
4. Ayurveda Treatment:

   There are various Ayurveda treatment options to cure heartburn. You could simply opt for medications or can choose to stay in a wellness resort/ayurveda hospital to completely get rid of your heartburn and other Gastrointestinal problems.

5. Surgical interventions:

   Following are surgical treatments that aid to relieve and cure the GERD and its symptoms.

   • Fundoplication:

     This is the standard surgical intervention to tighten and strengthen the LES. In this, the higher part of the stomach is draped around the outer side of the lower part of the esophagus to give strength to LES. This surgery can be done as

     • Open fundoplication surgery: Open Fundoplication surgery is done when either it is not possible or not safe to perform the laparoscopic surgery. The reasons can be many, which include history of prior abdominal surgery, obesity or bleeding during the operation. The surgeon is the best person to decide which procedure is best suited for you.
     • Minimally invasive/ Laparoscopic Fundoplication (also known as Nissen Fundoplication): Laparoscopic Nissen fundoplication is a minimally invasive procedure which is done to restore the function of the lower esophageal sphincter (the valve between the esophagus and the stomach) by wrapping the stomach around the esophagus.

When is GERD surgery needed?

If non surgical methods have failed to relieve you of heartburn, or you have any of the following conditions, surgery may be an option for you:

• Inflammation of the esophagus, the tube that connects your mouth and stomach.
• An esophageal constriction that isn't caused by malignancy.
• Barrett's esophagus is a condition in which the cells of the esophagus alter as a result of acid reflux.

How is the GERD Operation Done?

Fundoplication is the most common operation for persistent heartburn. The surgeon can operate on you from the outside using special instruments such as a tiny tube with a light and camera called a laparoscope, or they can directly touch the sections of your body they're working on (open fundoplication).

Your surgeon will make a large cut in your belly for open surgery or a series of minor cuts for laparoscopic surgery. The top half of your stomach will next be wrapped around the bottom part of your esophagus and sewn in place. This helps prevent stomach acid from backing up into the esophagus by tightening it.

LINX Surgery

A laparoscope is used to place a ring of titanium beads around the outside of your lower esophagus during the LINX surgery. The valve between the esophagus and the stomach is strengthened as a result of this. Food and liquids are still permitted to pass through.

Endoscopic Procedures

These are usually the initial steps taken by your doctor. A flexible tube called an endoscope will be inserted into your mouth and into your esophagus and stomach. They can look into your body because the tube has a light and a camera. They can also obtain tissue samples and perform surgery using the endoscope and specific instruments.

They can connect the end of the esophagus to the top of the stomach with a collection of small instruments at the end of an endoscope. Alternatively, they could sew pleats in the lower esophagus to reinforce the area.

Stretta Procedure

The doctor uses high-energy waves to generate small amounts of scar tissue in the lower esophagus wall during the Stretta procedure, also known as radiofrequency treatment. Heartburn and other acid reflux symptoms are frequently relieved as a result of this. For a decent result, you may require more than one treatment.

These treatments are frequently effective, albeit they may not be as effective as surgery. They don't, however, necessitate cutting into your stomach, general anesthesia, or a hospital stay.

What is Recovery after GERD Surgery (Nissen Fundoplication) like?

It's possible that your throat will be sore for a day or two after surgery. You'll require a temporary nasogastric (NG) tube if you or your child undergoes open fundoplication surgery. While you recuperate, the tube clears the stomach of digestive secretions.

You or your child may also require an IV (intravenous) line to keep you hydrated until you are able to eat again. Once you've passed gas or had a bowel movement, you can resume eating. Those acts indicate that your body is resuming its normal function.

Adults and children may need to stay in the hospital for 2-3 days after surgery. The length of recovery varies on whether the surgeon employed a laparoscopic or open method, as well as whether there are any other medical issues.

Laparoscopic surgery allows many patients to return home in a day or two.

Many surgeons prescribe a soft foods diet for the first seven to ten days after surgery. Within a few days of surgery, you should be able to resume normal activities and gentle exercise.

After returning home from the hospital, most children are able to return to school within a few days. For at least three weeks, they should avoid intense exertion. Activity restrictions differ between laparoscopic and open treatments.

You may feel some pain and discomfort for a few days which can be resolved with pain medications. You can resume your daily activities within a week, but heavy work and exercises should wait for 8-10 weeks. Your doctor may advise you to start with a liquid diet and gradually switch to semi solids and then solid food.

What Results can I Expect from GERD Surgery?

The results of Fundoplication surgery for GERD are good. You can expect relief from the acid reflux syndrome. Acid reflux medicines are usually not required after the procedure. Relieving GERD makes you more comfortable and lowers the risk of Barrett's esophagus. Barrett's esophagus increases your chances of getting esophageal cancer.