Antirefluxplasty is an operation that is used to treat reflux disease. Antirefluxplasty is performed via laparoscopy and is divided into three surgical steps: hiatoplasty, gastropexy and fundoplication. As a rule, anti-reflux surgery requires a one-week stay in hospital. This is followed by a rest period of 6 to 8 weeks.
Here you will find further information and selected anti-refluxplasty specialists and centers.
Anti-reflux surgery is a surgical treatment option for reflux disease. This is also known colloquially as "gastroesophageal reflux disease" or heartburn. The following video shows how heartburn occurs with reflux disease:
Heartburn is caused by acidic gastric fluid rising up into the oesophagus, in extreme cases even into the throat.
The most common cause of heartburn is a malfunctioning sphincter muscle at the entrance to the stomach. As a result, the stomach no longer closes properly to the oesophagus and stomach contents can rise. This clinical picture is known as reflux disease.
Comparison of a normally closed stomach and a stomach with a diseased gastric sphincter © bilderzwerg / Fotolia
A hiatal hernia is also a possible cause of heartburn. The diaphragm is a muscle that separates the chest from the abdominal cavity in the form of a stretched umbrella.
The oesophagus leads through a gap in the diaphragm from the pharynx into the abdomen, where it merges into the stomach. This gap (known as the oesophageal hiatus or diaphragmatic hiatus) is a natural weak point for a hernia.
A hernia occurs when the edges of this diaphragmatic hiatus slowly move apart. This enlarged gap may allow the stomach to move upwards into the chest cavity.
Fig. 1: In the normal situation, the stomach (pink) lies below the diaphragm (green), which separates the stomach cavity from the chest cavity (thorax, gray).
Fig. 2: In the case of a diaphragmatic hernia, the opening in the diaphragm for the esophagus to pass through is widened so that it can slide upside down into the chest cavity, taking parts of the stomach (pink) with it.
This change in position means that the gastric sphincter no longer functions properly. As a result, stomach acid can flow into the oesophagus without a barrier and cause heartburn.
The aggressive gastric juice can lead to severe burns to the oesophagus (oesophagitis). This changes the fine tissue structure of the oesophagus (metaplasia), which can lead to the development of cancer.
The main cause of a hiatal hernia is a congenital weakness of the connective tissue. In addition, obesity and a strong and persistent increase in pressure in the abdominal cavity, e.g. with
the development of this hernia.
Eating habits can also contribute to the development of a diaphragmatic hernia. Eating too quickly and frantically and frequently swallowing insufficiently chewed chunks of food increase the risk of the disease.
The diagnosis of reflux disease is based on a physical examination and gastroscopy. This can be supplemented by
can be used. If the inflammation of the esophageal mucosa caused by reflux (esophagitis) is already pronounced, tissue samples are required. This allows malignant changes to be ruled out or detected in the laboratory.
Heartburn is initially treated with medication . However, this only alleviates the symptom of reflux disease and does not eliminate the cause.
Anti-reflux surgery (also known as fundoplication or hemifundoplication) is an option if
Antirefluxplasty can end years of medication. It can also partially prevent the development of esophageal cancer (carcinoma prophylaxis).
Antirefluxplasty is performed via laparoscopy. The doctors insert a camera and small instruments into the abdomen through 5 to 6 small incisions measuring 0.5 to 1 cm in length. The procedure therefore takes place inside the body. The surgeon uses the camera to orientate himself directly in the surgical area.
In anti-reflux plastic surgery, this mechanical change in the body is corrected in 3 surgical steps:
Hiatoplasty is used to reduce the gap in the diaphragm that has become too large so that only the esophagus can pass through.
The edges of the gap in the diaphragm are rejoined using special sutures. Depending on the findings, a plastic mesh is sometimes attached to these sutures. This plastic mesh remains permanently in the body and causes more scarring on the diaphragm. This significantly reduces the risk of recurrent rupture.
Over time, the mesh is completely enclosed by the scar tissue. It then lies "inside the body outside the body" (extracorporealized mesh).
Fig. 3: View of the dilated diaphragmatic legs (V-shaped) from the inside during a laparoscopy. The esophagus is at the top right of the image and its gaping passage between the diaphragmatic legs can be seen.
Fig. 4: In the so-called posterior pillar plasty, the diaphragmatic legs are brought together using single button sutures to narrow the opening. The esophagus is held to the upper right with a plastic rein.
Fig. 5: To prevent a new diaphragmatic hernia, the suture site (see Fig. 6) is additionally secured with a mesh. The esophagus is held upwards to the right with a rein from the picture.
During gastropexy, the surgeon pulls the stomach section out of the chest cavity back into the abdominal cavity. There he attaches it to the diaphragm on the right and left with staples or sutures.
This prevents the stomach from slipping upwards again. It also relieves pressure on the sutures of the subsequently attached fundus sleeve.
Fundoplication is the formation of a sleeve from the gastric dome in order to reinforce the sphincter muscle from the outside.
The so-called gastric dome, a protrusion in the upper third of the stomach, is first freed from its adhesions to the spleen. The surgeon then pulls it through below the oesophagus and attaches it to the right and left of the oesophagus. As a result, the oesophagus lies as if in a "stomach bed".
The stomach now surrounds the esophagus at the level of the sphincter muscle, thereby reinforcing it (Toupet procedure).
In another type of treatment, the esophagus is enclosed 360° by the gastric sleeve (Nissen treatment).
Fig. 6: Wrapping of the esophagus with the gastric dome (Toupet procedure). Both gastric folds (light-colored tissue)
approach each other again in front of the esophagus without meeting.
Fig. 7: In the Nissen approach, the gastric fold is completely wrapped around the esophagus and the upper part
of the stomach entrance. This means that the region is completely surrounded by gastric tissue towards the front
. The liver can be seen at the top left of the image.
The doctor decides which type of treatment promises the best results based on the available findings.
Complications occur less frequently in centers specializing in antirefluxplasty.
However, as with any operation, there is a risk of damaging neighboring organs. These include
If the spleen is injured and bleeds, it is necessary to remove it in very rare cases. This would result in the need for vaccination against diseases against which the spleen would otherwise provide protection.
If a large part of the stomach is displaced into the chest, the pleura of the lungs may be injured when it is displaced backwards. In most cases, this heals without any problems after appropriate suturing of the injury.
In rare cases, an additional drainage tube is placed under the lung in addition to the suture during refluxplasty surgery.
Temporary swallowing difficulties may occur for a period of 6 to 8 weeks. This is due to the change in organ position and swelling in the surgical area. Patients should therefore eat more slowly and, of course, chew well. The dysphagia usually disappears without any special treatment.
Some patients complain of a feeling of fullness in the upper abdomen over a period of 6 to 8 months. This is also a matter of habituation. Before anti-reflux surgery, patients often unconsciously swallow air again and again to "swallow away" the heartburn. This unconscious swallowing does not stop immediately after the operation; the body only gets used to it slowly.
The air that is now swallowed can no longer escape upwards as well because the stomach sphincter is now "working" again. It has to find its way through the intestines, which results in a feeling of fullness.
Some patients are no longer able to vomit after anti-reflux surgery, or only with difficulty. This is ultimately a sign that the operation was successful, as the antirefluxplasty is intended to prevent reflux of stomach contents.
A hospital stay of approximately one week is to be expected for anti-reflux surgery. The patient can drink again on the day of the operation. Many patients are already drinking coffee or orange juice again, which they had to do without for a long time due to heartburn.
On the first day after the operation, the patient is given a liquid diet, followed by porridge the next day. After that, a normal full diet is served.
After the operation, the patient should take it easy physically for 6 to 8 weeks. This gives the body the opportunity to form a strong scar in the area of the operation. This reduces the risk of another diaphragmatic hernia ("recurrent hernia").
The patient should also change their eating habits to prevent a recurrent diaphragmatic hernia. This includes
No further special aftercare is required for this operation.
After the necessary rest period of 6 to 8 weeks, the patient can resume their normal life.
Anti-refluxplasty is a low-risk procedure for the treatment of heartburn and hiatal hernias in appropriately specialized surgical centers.
The Leading Medicine Guide's quality assurance is ensured by the following acceptance prerequisites.
