¿Cuándo y cómo debe operarse el Reflujo Gastroesofágico (ERGE)?

Written by: Dr. Ramón Díaz Conradi
Edited by: Anna Raventós Rodríguez

Burning or "burning" behind the breastbone it is used to describe what in medical terms is known as "heartburn" or gastroesophageal reflux disease (GERD), ie the contents of the stomach back up into the esophagus due to a failure of the sphincter Esophageal valve (IAS), a valve that separates the esophagus from the stomach.


As it rises up the esophagus, the gastric acids produce burning behind the sternum, which can reach the neck. Other symptoms of GERD include chronic coughing with hoarseness, frequent vomiting, and chronic throat involvement (in fact, many patients are diagnosed at the Otorhinolaryngologist's office).


Causes of Gastroesophageal Reflux (GERD)

When eaten, food passes from the mouth to the stomach through the esophagus. When the lower esophageal sphincter (a valve that separates the esophagus from the stomach preventing gastric juices from "climbing" into the esophagus) is altered, gastric acids pass into the esophagus in an uncontrolled manner, resulting in GERD or Gastroesophageal Reflux Disease


The causes of an alteration of the lower esophageal sphincter (IAS) are multiple, the most frequent being a hiatal hernia. However, having a hiatal hernia does not mean that there will be GERD; You can have GER without hiatal hernia.

Gastroesophageal Reflux (GERD)


There are patients who by their constitution or birth have an alteration in the functioning of the ISS; There are also external conditions that alter the IEE, such as alcohol, tobacco, vigorous exercises ... etc.


Gastroesophageal reflux treatment

To treat gastroesophageal reflux, three steps must be followed gradually:


  • Changes in habitual life. Easily digestible foods will be avoided by avoiding irritants such as alcohol, spices, coffee and copious meals at all times. It is also advisable to exercise softly and lift the head of the bed 20 cms., Because at night is when more episodes of reflux occur (we never have to go to bed at the end of the meal or dinner, but we have to wait 60-90 minutes for "digestion").
  • Drug treatment
  • Surgery. Patients who do not respond to medical treatment or can not follow it are subsidiaries of surgery since the pathology is to be resolved in 90% of cases.


Advantages of reflux treatment with laparoscopy

In the past, make an incision of 20-30 cm. In the abdomen was the only way to operate this disease; Today, through laparoscopic surgery, the gastroesophageal reflux can be repaired by means of 4-5 incisions of 0.5-1 cms.


The main advantages of this technique are:


  • Less postoperative pain
  • Shorter hospital stay
  • Rapid tolerance to food
  • Rapid onset of bowel function
  • Rapid recovery in normal activity.
  • Improved aesthetic results along with lower index of hernias or wounds


Candidates for laparoscopy to treat gastroesophageal reflux

Although laparoscopic surgery of Gastroesophageal Reflux has many advantages, it may not be appropriate for some patients, you should always consult your surgeon to find out which is the most appropriate technique since there are certain cardiac, respiratory and neurological diseases that contraindicate surgery Laparoscopic.


Preparation of the patient before a laparoscopy to treat gastroesophageal reflux

The day before laparoscopy to treat gastroesophageal reflux, the patient will perform an intense personal hygiene that will consist of performing 2 showers. No food preparation other than fasting is required eight hours before the intervention (taking only the medications you are given with a small sip of water if necessary). The patient should stop taking medicines that alter blood clotting, such as Aspirin and derivatives, Sintrom and some anti-inflammatories 5 days before the intervention


Laparoscopic Gastroesophageal Reflux Surgery

The term laparoscopic surgery refers to the way the surgeon accesses the abdominal cavity. The abdomen is inflated with gas (CO2) so that a TV camera can be inserted into the abdomen along with the instruments necessary to perform the surgery. The intervention is done by looking at a monitor that shows the images of the camera inserted in the abdomen. Then the surgery explained previously to the patient in the consultation.


Postoperative of gastroesophageal reflux surgery

The postoperative of the intervention will depend on the patient and the type of surgery; Before sending it to plant, will pass through an intensive or average monitoring unit.


At 24 hours the patient will start the intake of liquids and crushed food (if their tolerance is good); 48 hours after the intervention, provided that the tolerance is correct, the patient will be discharged. Then you can perform the exercises that the abdominal discomfort will allow you, recovering your normal life 5-7 days after the procedure.


The patient will be fed by Túrmix 10 days, going to the consultation to remove points and giving him the dietary guidelines according to his evolution.


Risks of Gastroesophageal Reflux Surgery

Complications in gastroesophageal reflux surgery are rare , but they can occur (bleeding or infection, both inside and outside the abdomen).


Internal organs such as spleen, colon, small intestine, etc. can also be injured.. But as a rule they are very rare. Thromboembolic phenomena can also occur, despite the fact that preventive drugs are given.


It is important to recognize early complications to treat them as urgently as possible.


The surgeon should be called in the following cases:


  • Fever greater than 38 ° or chills
  • Hemorrhage from wounds or the rectum (the latter occurs in small amount the first days of the intervention). - Abdominal pain that is increasing or swelling of the abdomen.
  • Impossibility to urinate.
  • Redness or suppuration of one of the wounds
  • If you have respiratory symptoms such as persistent cough or costal pain.
*Translated with Google translator. We apologize for any imperfection

By Dr. Ramón Díaz Conradi

Dr. Diaz Conradi has made since 1990 over 3,200 interventions in Laparoscopic Surgery, covering all types of digestive diseases (liver, gallbladder, bile duct, pancreas, esophagus, stomach, small intestine, colon and rectum), spleen, morbid obesity (bands and by-pass), adrenal surgery and emergency surgery (abdominal trauma, acute appendicitis, cholecystitis, intestinal obstruction, perforation of hollow viscera and urgent adnexal pathology). In addition, he is a frequent speaker and lecturer at the Universidad San Pablo CEU.

*Translated with Google translator. We apologize for any imperfection

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