What is reflux?
Reflux is the backflow of stomach contents into the oesophagus. Normally, a sphincter muscle at the junction between the oesophagus and the stomach prevents this. If this barrier is impaired, the typical symptoms arise: heartburn (pain or pressure behind the breastbone), acid regurgitation, hoarseness in the morning, chronic cough or bronchitis.
The cause is often the combination of a weak sphincter and a hiatal hernia, in which part of the stomach slides through the opening in the diaphragm into the chest cavity.
When does surgery make sense?
The first step is changing diet and lifestyle habits. For severely overweight patients, I first recommend weight reduction. This leads to a clear improvement for many. Medication reduces stomach acid but does not prevent the backflow of stomach contents – and lifelong use can have side effects and long-term consequences. If the lining of the oesophagus is damaged over years, the risk of oesophageal cancer also increases.
Surgery eliminates the cause. In approx. 90–95 % of patients it achieves a long-term cure or at least a significant improvement in quality of life.
The operation
I operate minimally invasively using keyhole technique (laparoscopically) under general anaesthesia. Only in complex situations, such as very large hiatal hernias or after previous operations, can the Da Vinci system offer an advantage.
Hiatoplasty – closure of the hiatal hernia
If there is a hiatal hernia, the stomach is moved back into the abdominal cavity and the opening in the diaphragm (hiatus) is narrowed to a normal size. I only use a mesh for very large hernias.
Stomach wrap (fundoplication)
Next, part of the stomach is wrapped around the lower end of the oesophagus. This creates a valve that prevents reflux. As a rule, I use the Toupet wrap (270°). It is technically more demanding than the Nissen wrap (360°), but – especially in the first year – causes swallowing difficulties, bloating or problems with belching and vomiting less often.
The operation takes about an hour. Most patients leave hospital on the following day.
After the operation
- Painkillers are usually only needed for a few days. Bed rest is not necessary – feel free to move around normally.
- In the first two weeks you should chew well; after that, normal eating is usually possible again and desirable.
- Avoid heavy lifting and strong straining in the first two months.
Which examinations are needed beforehand?
The most important thing is the detailed consultation at one of my practices. Feel free to bring any existing findings with you – and if you have not yet had any examinations, I will help you arrange them.
- Gastroscopy: necessary for all reflux patients. I prefer to perform it myself.
- Swallowing X-ray (videocinematography): shows the act of swallowing and can detect other diseases and motility disorders of the oesophagus. The examination should be carried out at the practice of Prof. Pokieser, as this institution has the greatest experience with this examination in Austria.
- Manometry and pH-metry: functional examinations of the oesophagus for assessment before an operation. We determine which measurements are required on the basis of your findings.
Frequently asked questions
How long does reflux surgery take?
About an hour. Most patients can leave hospital on the day after the operation.
What do I need to bear in mind when eating after the operation?
In the first two weeks you should chew well; after that, normal eating is usually possible again and desirable.
Which wrap do you use?
As a rule, the Toupet wrap (270°). It causes swallowing difficulties and bloating less often than the Nissen wrap (360°).