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DIAPHRAGMATIC HERNIA - GASTRO-OESOPHAGEAL REFLUX - SURGERY IS THE ONLY DEFINITIVE SOLUTION!

WHAT IS GASTRO-OESOPHAGEAL REFLUX (GOR)

Between the oesophagus and the stomach lies the "gastro-oesophageal sphincter" which prevents reverse flow of food and fluid from the stomach to the oesophagus. Gastro-Oesophageal Reflux (GOR) is this reverse flow. Up to a point, the oesophagus can deal with this phenomenon, but when it becomes frequent, it overcomes the oesophagus' resistances and the patient begins to exhibit symptoms.

 

GASTRO-OESOPHAGEAL REFLUX (GOR) SYMPTOMS

The most common symptoms are those described by patients as "Heartburn", in other words an intense pain behind the sternum and a sour taste in the mouth. It may also manifest itself with frequent occurrences of pharyngitis, unexplained chronic cough, hoarseness in the voice, or frequent respiratory infections caused by aspiration, which may also result in asthma. Sometimes pain of angina may occur, which is a pain like a heart attack. Many patients wake up suddenly in the middle of the night with a feeling of chocking and shortness of breath.

CAUSES OF GASTRO-OESOPHAGEAL REFLUX (GOR)

Anything that causes an increase in intraabdominal pressure, e.g. obesity, pregnancy, heavy weight lifting, chronic cough etc. Often, GOR is due to a diaphragmatic hernia, in other words, conditions in which part of the stomach bulges into the chest area. Also, poor eating habits are implicated in the emergence of GOR.

DIAGNOSIS OF GASTRO-OESOPHAGEAL REFLUX (GOR)

 

The diagnosis is simply done via a Gastroscopy. The diagnosis is confirmed by the "pH metry" of the oesophagus, a test that records how many times a day and for how long the fluid from the stomach reflux towards the oesophagus.

WHAT ARE THE RISKS OF GOR?

Patients suffering from GOR for a long time are at risk of oesophagitis (1st, 2nd, 3rd or 4th grade). Severe oesophagitis over time can evolve into a condition called Barrett's oesophagus, which can develop into Oesophageal Cancer. In chronic cases, the risk for Cancer of the Larynx also increases.

TREATMENT OF GASTRO-OESOPHAGEAL REFLUX (GOR)

Surgical treatment is the only actual cure for GOR. The procedure performed is called Nissens’ Fundoplication. In this procedure, the upper part of the stomach, called the Fundus, is wound around the lower portion of the oesophagus like a lifebuoy, creating a high-pressure zone that applies external pressure to the oesophagus. The aim is to create an external pressure valve that prevents reflux. The operation is now only performed robotically or laparoscopically and in experienced hands has excellent results. The surgery is performed using total narcosis. The surgical robot offers the surgeon numerous advantages compared to the simple laparoscopic method. The view is three-dimensional and with great magnification. The surgeon can suture and tie knots with great ease inside the abdomen and there is no bleeding since even very small vessels are recognized and dealt with accordingly. In the aftermath the patient requires no transfusion, has no pain and is mobilised very quickly, in this way avoiding thrombosis and respiratory infections among others. The patient enters the hospital on the day of the operation. The day after the operation an X-ray check is performed to make sure everything is as it should be. On the same day (and for about a week) the patient is fed with pulpy - watery food and in the afternoon may return home. Via the application of minimally invasive techniques (Robotic & Laparoscopy), the severity of the surgery, as compared to the past when a large incision was made, has been reduced and the effects on the patient are almost nil. The effectiveness of the method has been tried and tested. Following surgery, the patient returns to his/her normal life without restrictions.

✍️ By Elena Karafoka-Mavrou, GI SURGEON, Director of the Surgical clinic at, METROPOLITAN GENERAL with specialization in  stomach, colon, pancreas, small intestine, haemorrhoids, hernias and SURGICAL ONCOLOGY.