Heartburn, also known as gastroesophageal reflux disease (GORD), effects almost half our population at some stage in our lives. For most people, it is the unpleasant feeling of indigestion in the pit of your stomach or burning pain in the chest which comes after overeating. It often effects people of a night-time and is worse when lying down. Most people who experience these symptoms occasionally can self-medicate with “over the counter” treatments such as Gaviscon or Mylanta, and can avoid attacks in the first place by avoiding the substances which are known to cause them, most commonly things such as alcohol, caffeine, spicy foods etc.
For some patients however, reflux is a more serious problem and they need to take daily anti-reflux medication (commonly known as proton pump inhibitors, or PPIs) to avoid the unpleasant symptoms.
Hiatus hernia, is the condition where the valve mechanism between the oesophagus and the top part of the stomach is defective, allowing the top of the stomach to slip up through the diaphragm muscle and into the chest. These hernias can be associated with heartburn symptoms (GORD). Hiatus hernias are diagnosed by an endoscopy, where a surgeon looks down into your stomach with a small telescope. A special x-ray where you drink contrast material and then have x-rays taken as you swallow it, can also be useful in making the diagnosis. Patients with very large hiatus hernias may experience other unpleasant symptoms in addition to heartburn, including difficulty swallowing, regurgitation of food, chest pain, shortness of breath and chronic cough.
Anti-reflux surgery is a highly specialised keyhole operation to prevent GORD and repair hiatus hernias when they are present. The surgery involves repairing the diaphragm muscle and restoring the valve mechanism between the oesophagus and the stomach so that reflux cannot occur. The surgery is generally reserved for patients who have very severe reflux symptoms. The operation takes around two hours, and you can expect to spend 2-3 nights in hospital recovering. After the surgery, patients have to stick to a diet of soft food for a period of 6 weeks, until the swelling from the surgery has subsided. We will get a dietician to talk you to about this before you are discharged home from hospital. The surgery is very effective at improving patients reflux symptoms, but can have long term side effects including bloating and flatulence. Your surgeon will give you further written information on the details of surgery at the time of your consultation.