The esophagus allows food to be delivered from the mouth to the stomach and is approximately 35-40 cm long. At the point where it joins with the stomach, the muscles up to 2 cm in length pass through the natural opening in the diaphragm called the Hiatus, gaining a special structure and forming a kind of one-way valve mechanism called the sphincter. In this way, the stomach contents do not pass up into the esophagus while the food goes down to the stomach. Reflux occurs as a result of the malfunction of this system. Reflux is when stomach contents (acid, bile, food and gastric enzymes) escape into the esophagus above the physiological limits and cause complaints. The most common cause of reflux is the sphincter deficiency, which is called the valve at the lower end of the esophagus at a rate of 70%. Again, with the enlargement of the place where the esophagus passes through the diaphragm, the stomach slipping upwards can also cause reflux.
There may be chronic cough and Bronchitis. BARRET can cause esophageal cancer and lower esophageal cancer in the later stages due to varying degrees of inflammation (esophagitis), ulceration, stricture (stricture) in the esophagus due to the damage it has made in the lower end of the esophagus.
The most basic diagnostic tool is endoscopy. Stomach hernia, esophagitis (esophagitis), Barret esophagus are easily detected with endoscopy.
Sometimes, patients with normal endoscopy should perform an examination called 24-hour pH monitoring. After the endoscopic examination, a thin catheter is inserted from the nose of the patient to the lower end of the esophagus and the catheter is connected to a wallet-sized device and records the pH changes in the lower end of the esophagus that occur when the patient is lying or standing, eating or hungry, during the day or while sleeping for 24 hours. A special diet is not given before and after the procedure; the patient continues exactly as he lived before. If there is any stomach medication used 3 days before the procedure, it is discontinued. The data collected at the end of 24 hours are analyzed on the computer and the decision is made for surgery by looking at the degree of acid reflux.
Surgery is not performed for every reflux patient. Nutrition and some lifestyle changes are recommended first.
Who should have surgical treatment?
Reflux surgery was first performed by Prof. Dr. It was started by Rudolf Nissen with the surgery he performed on a 28-year-old patient at Istanbul University Faculty of Medicine and is still the gold standard of reflux surgery.
Reflux surgery; It is based on the principle of closing the opening in the hiatus, if any, and the escape of the part of the stomach called the fundus, like a sleeve at the lower end of the esophagus, into the rib cage and creating an artificial sphincter.
The procedure is performed laparoscopically (closed) under general anesthesia with special tools entered through 0.5 and 1 cm holes in the abdomen. When everything goes well, your surgery will take approximately 1 hour. After the surgery, patients stay in the hospital for 1 night. For the first 2 weeks, a liquid and soft food-based diet is recommended. There is no restriction afterwards, provided that you chew the foods well.
Reflux complaints will disappear immediately after the surgery and patients will start to experience this comfort immediately after the operation. However, if there are complications (such as esophagitis), it will take time to resolve them. After reflux surgery, the person will continue his normal life from where he left off. The surgery will not restrict any of its activities.
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