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Preparing for Acid Reflux Surgery

You may have followed your doctor’s advices, taken your medication, raised the bed headboard, never eaten late-night snacks and simply done everything in the "to-do" list for people with GERD. But if your condition doesn’t improve, then antireflux surgery may be necessary to combat your GERD symptoms and its complications. Surgery is required on about 10 percent of people with GERD. Some younger patients may also decide to undergo the surgery although medication can control their condition, simply because they don’t want to take pills for the rest of their lives.

Nowadays, GERD surgery is not considered as a major procedure and doesn’t require months of recovery period. Obviously, patients should rest adequately after a surgery and the recovery rate may depend on the age and basal health condition, for example a 50 year old individual with a serious illness may require longer recovery period. Generally, a patient can be released after two days of stay, followed by ten days of rest at home. Although GERD surgery is not considered to be risky, there are still some risks on every surgical procedure and complications may still occur. So, you should really consider whether you need a GERD surgery.

Before making a decision, the doctor evaluates your case carefully. Some people are good candidates for GERD surgery, for example because medication treatment will have little effects on their conditions.

These are people who should undergo GERD surgery:

• Those who have esophageal bleeding or esophagus stricture

• Those who don’t respond well to medication

• Those who have esophageal ulcers that won’t heal easily

• Those who have a large hiatal hernia

• Those who have a relapse each time the medication is stopped

• Those who have high-grade dysplasia. About 50 percent of GERD patients with high-grade dysplasia are found to have cancer that is not easily detected during endoscopy. While low-grade dysplasia refers to abnormal cells, they’re still behaving like normal cells, on the other hand, GERD patients with high-grade dysplasia on the esophagus have abnormal cells that bear very little resemblance to normal cells, which are one step away from cancerous cells.

Although your doctor tells you that you may need a surgery, you shouldn’t rush off to the nearest hospital, unless you have an emergency. And even after you’re scheduled for a surgery, you should undergo an array of preliminary tests. Patients with unverified GERD, will receive an endoscopy biopsy. Confirming your condition is often important because some diseases mimic GERD, which make a surgery useless as the patient has a healthy esophagus. You may also receive a pH monitoring for 24-hour to check the acidity of esophagus.

Your overall health condition will also be evaluated and the doctor may require urine and blood tests check whether you have an existing infection or not. Although antireflux procedure isn’t a dangerous procedure, it can prove to be deadly in the hands of incompetent surgeons. It is therefore necessary that you choose a hospital that has experienced doctors, surgeons and nurses.

Before committing yourself to an antireflux surgery, there are a few questions you should ask to your doctor. These are some common questions:

• Why I need to have a surgery?

• What are likely risks in my case if I undergo the surgery?

• How long would I stay in hospital?

• How long should I take a time off from daily activities?

• How much time is needed for a complete recovery?

• Are there people who undergo this surgery when they’re at my age and with similar conditions like mine? If the doctor provides some names, you should contact at least one of them. It is often very useful and reassuring to talk to a person who had undergone the same procedure. You should be aware that the outcome of an antireflux surgery can be different in each people although there are similarities in age and overall health conditions. You shouldn’t be offended if the doctor refuses to give you names, as he is required to protect the patients’ privacy. Besides, if the patients don’t want their names to be released, it is quite likely that they won’t help you.

• Should I take my medications on the morning before the surgery? It’s likely that the doctor will say no. If you have a diabetes and need to take regular dose of insulin, ask whether you should take it and how much.

• What are problems that may or will occur after the antireflux surgery?

• How many antireflux procedures have you performed? Although there is no "the right number", it is often inadvisable to make yourself the first learning object of an inexperienced surgeon. Just like other surgeries, antireflux surgery also involves a learning curve and experienced doctors will usually produce better and satisfactory results. In general, surgeons who have performed approximately 30 surgeries should be experienced enough.

Feel free to ask other questions to your doctor, which is suited to your current condition. Remember, your doctor could be busy and you should ask essential questions first. If he has more time to spare, you can safely ask other less important questions. A good doctor should agree to discuss about all of your concerns and explain everything clearly, so you’ll know what to expect from the procedure. Don’t forget to take notes as the doctor provides important facts a detail, so you don’t need to ask the questions again in the future. Occasionally, the doctor may use hard-to-understand medical terms, so you should ask him to explain it to you again with simpler words. You shouldn’t be too impressed by offers from new hospitals or clinics like free shirts as giveaways or a pick up with nice car. The doctor’s track record should be your primary consideration.

Before deciding to have a surgery, these are other things to consider:

• Does your insurance cover antireflux surgery?

• Do you have to get a referral or approval from someone to have the surgery?

• What should I bring to the hospital?

• What shouldn’t I bring to the hospital?

To answer the above questions you need to call several people, for example, the insurance company representative or the hospital staff. You should also ask for an information handout about the procedure from the hospital as it often covers many key facts.

Before undergoing a surgery, you should know common types of antireflux surgery:

Fundoplication

Fundus or the upper curve of your stomach is wrapped around your esophagus and then sewn into place. Consequently, the valve between your stomach and esophagus is strengthened.

Partial Fundoplication

Also called the Toupet procedure, the stomach is only wrapped partway around your esophagus.

Gastropexy

In this procedure, the surgeon attaches your stomach to the diaphragm, which prevents upward movement toward the chest.

Stretta Radiofrequency Procedure

Radiofrequency energy is streamed through an endoscope, which can tighten your lower esophageal sphincter. This is a non-invasive procedure and potentially good alternative to typical antireflux surgeries. Ask your doctor, whether Stretta radiofrequency is suitable for your condition. Because this procedure is relatively new, ask the doctor about its latest developments, including latest success rate and recently discovered complications.





Gary Wickman

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