Indications:
Majority of patients are well controlled on medication and only a small subgroup will require surgery. Indications include, volume reflux, symptomatic hernia, side effects from medication or need to avoid life-long medical treatment.
Procedure:
A hiatus simply means a gap/opening. A hernia is a bulge or a weakness. In this case, the stomach bulges through a hiatus up into your chest. Sometimes the stomach gets stuck within the chest. Your surgeon will discuss the procedure with you in detail and will answer any questions you may have before the operation. The aim of the operation is to bring the stomach down from the chest and to stop the acid reflux. A laparoscope is inserted through a small (1 cm) incision above the belly button (umbilicus). Four other similar incisions are made to insert the necessary instruments for the operation. The herniated stomach and the lowest part of the oesophagus are returned to their normal positions i.e. below the diaphragm. Part of the stomach (fundus) is wrapped around the oesophagus to re-create a valve. The hiatus in the diaphragm is narrowed with stitches. The instruments are withdrawn, and the incisions are closed. In a small number of patients (approx. 5%) it may not be possible to operate via the laparoscope due to adhesions from previous operations, bleeding obscuring vision, awkward fatty tissue or other technical problems. It will then be necessary to revert to an open operation, where a larger incision is performed in the midline of your tummy to complete the operation.
- Most patients have a good result from the fundoplication operation without any complications. However, the main complication, (less than 2%) which can be serious, is injury to the oesophagus.
- There is also risk of injury to the stomach, colon, spleen and liver. These will usually be recognized at the time of surgery and may require an open operation to repair it. On occasion patients will present a few days later and then require a second operation.
- A small number of patients who have the laparoscopic fundoplication may develop problems either due to the wrap being too tight or the wrap slipping into the chest. These can sometimes be corrected by early laparoscopic re-operation lengthening the recovery time by a few days. To detect complications after laparoscopic fundoplication a barium swallow (x-ray) will sometimes be performed in the first 1-3 days after operation, this aides in checking the position of the wrap and exclude a leak from the esophagus.
- It is quite normal to experience some swallowing difficulties after this procedure. This is generally due to the swelling and bruising at the site of the operation, and while this will gradually resolve, it may take 3-6 months for swallowing to return to normal. In a small number of patients this can be more severe, and it may be necessary to dilate (stretch) the lower end of the oesophagus. This is usually done in our rooms with a flexible scope.
- Other risks are delayed return of bowel function, wound infection, deep vein thrombosis, pulmonary emboli, atelectasis and pneumonia. Late complications may occur such as a suture granuloma or a hernia at the site of the wound.
After your consultation:
- Obtain authorization from your medical aid and book your bed for your hospital admission.
- Carefully read through pre-operative information provided.
Day before surgery:
- Do not eat/drink after 22h00, the night before your surgery, unless otherwise specified by your surgeon or anaesthetist (you should be fasting for at least 6 hours before the procedure for solids but you are allowed to take clear liquids up to two hours before your procedure).
Day of surgery:
- Arrive for admission at indicated time on ‘Code & Consent’ sheet.
- Change into theatre attire, remove all valuable belongings.
Approximately 90 minutes.
Duration of hospital stay:
- 2-3 days (dependent on pain management, general state of patient and first bowel movement).
Activities:
- Refrain from strenuous activities (incl. exercise) for at least 4 weeks post-operatively.
Back to work:
- Sick leave required post-operatively is approximately 10-14 days.
Some pain and discomfort post operatively may be expected following any operation, but the following measures are used to lessen the pain experienced:
- Warming devises in theatre as well as warm intravenous fluids.
- Intra-operative pain medication through the drip.
- Post-operative medication through the drip, please inform the nurses if you are in pain so that medication will be administered to you.
- As close to one week after discharge as possible. Please contact the rooms to schedule an appointment.
More procedures performed by Dr Basson
A SKIN INCISION IS MADE AND THE CONTENTS OF THE ABSCESS IS DRAINED.
AN OPERATION TO REMOVE ONE (OR BOTH) ADRENAL GLANDS.
THE FISTULA TRACT IS IDENTIFIED AND IS OPENED ALONG ITS LENGTH, AND THE EXPOSED INSIDE OF THE TRACT IS THEN CLEANED OUT.
AN OPERATION TO REMOVE AN APPENDIX THAT IS INFLAMED/SWOLLEN/HAS RUPTURED/HAS FORMED AN ABSCESS.
AN OPERATION TO REMOVE LUMPS/TUMOURS OF THE BREAST.
AN OPERATION TO REMOVE PART OF/THE ENTIRE COLON.
AN ENDOSCOPIC EXAMINATION OF THE LARGE INTESTINE (COLON & RECTUM).
AN INCISION IN THE SKIN NEXT TO THE ANUS TO DRAIN PUS.
AN OPERATION TO REPAIR AN AREA OF WEAKNESS IN THE MUSCLES WHICH FORM THE LOWER FRONT OF THE STOMACH (IN THE GROIN REGION).
AN OPERATION THAT REMOVES EITHER PART OF THE STOMACH (PARTIAL) OR THE ENTIRE STOMACH (TOTAL).
AN ENDOSCOPIC EXAMINATION OF THE STOMACH.
AN OPERATION TO REMOVE COMPLICATED HAEMORRHOIDS (PILES).
AN OPERATION TO REPAIR AN AREA OF WEAKNESS IN AN AREA WHERE PREVIOUS MUSCLE CLOSURE HAS BEEN PERFORMED (AFTER AN ABDOMINAL OPERATION).
AN OPERATION TO REPAIR AN AREA OF WEAKNESS IN THE MUSCLES WHICH FORM THE LOWER FRONT OF THE STOMACH (IN THE GROIN REGION).
AN OPERATION TO REMOVE THE ENTIRE BREAST
WITH INTERSTIM THERAPY, A SACRAL NEUROMODULATION DEVICE IS IMPLANTED DURING A MINIMALLY INVASIVE PROCEDURE.
AN OPERATION PERFORMED TO RELIEVE GASTRO-OESOPHAGEAL REFLUX; MOST OFTEN ASSOCIATED WITH A HIATUS HERNIA.
OESOPHAGEAL MANOMETRY IS A TEST THAT MEASURES THE FUNCTION AND MOVEMENT OF THE OESOPHAGUS AND THE CHARACTERISTICS OF THE VALVE BETWEEN THE OESOPHAGUS AND THE STOMACH.
AN OPERATION TO REMOVE PARATHYROID GLAND/S OR PARATHYROID TUMOURS.
A PEG IS A WAY OF INTRODUCING FOOD, FLUIDS AND MEDICINES DIRECTLY INTO THE STOMACH BY PASSING A THIN TUBE THROUGH THE SKIN AND INTO THE STOMACH.
AN ELLIPTICAL INCISION IS MADE REMOVING THE AFFECTED SKIN AND INVOLVED TISSUE OVER THE BUTTOCK CLEFT.
AN OPERATION PERFORMED TO REPAIR A RECTUM THAT PROLAPSES THROUGH THE ANUS.
AN OPERATION PERFORMED TO STRENGTHEN THE WALL OF THE VAGINA WHICH STOPS THE RECTUM FROM PROTRUDING INTO THE VAGINA.
SURGERY TO REMOVE A PART OF YOUR SMALL BOWEL.
AN OPERATION TO REMOVE THE SPLEEN.
A STOMA IS AN OPENING ANYWHERE ALONG THE LENGTH OF THE BOWEL TO THE EXTERIOR SKIN SURFACE TO CREATE AN ARTIFICIAL ANUS.
AN OPERATION TO REMOVE PART OF/THE ENTIRE THYROID GLAND.
AN OPERATION TO REPAIR AN AREA OF WEAKNESS/SWELLING OF THE NAVEL (BELLY BUTTON).