Anti-Reflux Surgery and Obesity
Reflux is when stomach content passes back up into the Oesophagus. Stomach fluid is usually strongly acidic and can cause irritation and damage to the Oesophagus.
Reflux symptoms may include pain or discomfort (heartburn), regurgitation, vomiting and coughing.
Severe reflux can cause ulcers in the Oesophagus, strictures (narrowing caused by scar tissue), aspiration pneumonia, Barrett’s Oesophagus (change in the lining of the Oesophagus), Dysplasia (pre-cancerous changes) and less commonly Cancer of the Oesophagus.
Reflux becomes increasingly common as weight increases and usually improves significantly with weight loss.
Treatment with anti-acid medications makes the stomach content less acidic and may improve symptoms but reflux of fluid still occurs.
Conventional anti-reflux surgery involves repair of a hiatus hernia (if present) and a fundoplication (wrapping the top portion of the stomach around itself) to bolster the valve mechanism between the Oesophagus and Stomach minimising reflux.
Being morbidly obese puts more strain on the repair which is more likely to fail with development of recurrent symptoms over the longer term.
Being morbidly obese also shortens your life expectancy and is associated with numerous health conditions including high blood pressure, high cholesterol, diabetes, sleep apnoea and heart disease.
There are a number of available weight loss operations (including sleeve gastrectomy, Roux en-Y gastric bypass and gastric banding) that have been shown to assist achieving sustained, long-term weight loss and improve associated health conditions in addition to improving reflux symptoms.
Weight loss surgery can be more difficult to perform and has higher risks if a conventional procedure has previously been performed for reflux and/or hiatus hernia.
Therefore it is worth considering whether conventional anti-reflux surgery or a weight loss procedure is a more appropriate strategy for your individual circumstances as the first procedure usually has the lowest risks and best chances of success.
Your Surgeon will discuss these options in detail together with their risks and benefits to enable you to make an informed decision.
The following table can help when choosing the most appropriate strategy for you:
|Anti-Reflux Surgery||Weight Loss Surgery|
|I am only interested in controlling my reflux symptoms||I am also interested in the other health benefits of losing weight|
|I understand an assessment to confirm reflux is required including endoscopy and sometimes other investigations||I am prepared to have a comprehensive medical and dietary assessment requiring multiple appointments and investigations before any surgery|
|I understand that a soft diet is required for several months after surgery. Longer term dietary changes are also required including minimising alcohol, caffeine and fizzy drinks.||I understand that lifestyle changes including following a healthy diet and exercising regularly are also required for optimal results|
|I am not interested in long term follow up||I understand that ongoing follow-up and support will be required|
|I understand that all Surgery has potential side effects and risk of complications which should be balanced against the benefits of a procedure.||I understand that all Surgery has potential side effects and risk of complications which should be balanced against the benefits of a procedure.|
|Side effects including difficulty swallowing, inability to belch, bloating and increased flatulence are common and are a trade off for good reflux control. Complications are uncommon.||Side effects and complications are specific to different procedures and will be discussed with your Surgeon.|
|I understand that smoking increases the risks of an anaesthetic and operation and ideally should be ceased prior to having any elective surgery.||I understand that I must be a non-smoker or have quit for at least 3 months before any surgery can be performed.|
|I understand that some out of pocket costs may apply for the surgery depending on my health fund. Contact our staff for an estimate.||I understand that out of pocket costs will apply for the assessment, surgery and follow up. Contact our staff for an estimate.|