Surgery Side Effects and Failure Rate
Side effects of anti-reflux surgery are related to the creation of a valve at the lower esophageal sphincter where none previously existed.
These may include:
- Difficult, painful swallowing that may last up to three months, but is usually gone in 4 to 6 weeks. It may be associated with pain in the shoulder as well. Although liquids usually go down without any difficulty, some people may experience problems with them.
- Getting "full" easily since there is less stomach to hold food and liquids. Even a few bites can give the sensation of being full. This takes a few months to resolve in almost all patients. Meal size should be normal by six months. If a person eats less and gets full quickly, it stands to reason he or she will lose weight. Following anti-reflux surgery, patients can expect to lose 10 to 20 pounds. This resolves in a few months.
- The inability to vomit because the valve stops the regurgitation of material from the stomach into the esophagus. Should a patient get food poisoning, get the flu, or drink too much alcohol, he or she will feel sicker longer than others and may have more epigastric abdominal pain. This shouldn't cause harm. Medications can be prescribed during this time.
- The inability to belch. Although we try to make the wrap loose enough that patients can belch a little, those loud, roaring sounds from the pit of the stomach will be gone forever. If one ingests a lot of carbonation, such as in beer or a soft drink, he or she may experience a prolonged bloated sensation and even some epigastric discomfort until the gas passes from the stomach to the intestine.
- More flatus (gas) than before the operation. Air that is swallowed and carbonation that is ingested must now be passed via flatus. Although this can be annoying at times, most people gradually accommodate this and don't find it problematic.
The failure rate for anti-reflux surgery performed by surgeons with experience in the procedure and in the management of patients with GERD, is about 10% at 10 years. These results are from studies involving anti-reflux procedures performed with the conventional abdominal incision. Although 10-year follow-up studies with the laparoscopic approach are not yet possible, five year follow-up results with the laparoscopic approach are similar to those observed with the open approach.
If the operation fails
If reflux returns after an anti-reflux procedure, the procedure can be performed again or medications can be used. Complete evaluation to document the presence of reflux and to determine the causes of the reflux is necessary. The re-operation procedures can be performed either laparoscopically or open. However, the feasibility of doing the second procedure laparoscopically is less than when the procedure is done for the first time.
What is the chance the operation can't be done laparoscopically?
Overall, the likelihood that a procedure can be done laparoscopically the first time is greater than 95%. While obesity, a large liver or a very large hernia makes the procedure more difficult, it is usually some unforeseen problem that makes it necessary to convert to an open procedure. Therefore, it is impossible to predict who will need conversion to an open procedure, although the chance is less than 1% for our patients.