Heartburn/Hiatal Hernia Repair

What is Heartburn Surgery?

“Fundoplication” surgery is done to treat severe heartburn. A fundoplication tightens the connection between the esophagus (your food pipe) and your stomach to prevent acid reflux. This surgery can be done using minimally invasive techniques, meaning you will have very small incisions and a faster recovery time than traditional “open” surgery. The specific surgery you will have depends on a number of factors. Your surgeon will talk with you about which one is right for you.

What happens during a fundoplication?

• Before the procedure, your anesthesiologist will discuss the anesthesia plan that is best for you to make sure you are safe and comfortable during the procedure. Most people have general anesthesia, so you will be completely asleep and unaware of anything around you.
• During the surgery, you are monitored continuously to make sure you are safe and comfortable.
• The surgeon will use small robotic tools to make four or five very small incisions in your abdomen. They will then insert a laparoscope (a small tool with a camera) into your abdomen.
• If you have a hiatal hernia (a paraesophageal or diaphragmatic hernia), the surgeon will repair the hernia by pulling the stomach back in to the abdomen.
• The surgeon will then wrap the upper part of your stomach around your lower esophagus, which tightens the lower sphincter to prevent reflux.
• The surgeon will close the surgical incisions and you will be woken up and brought to the recovery room.

Possible risks and complications of a fundoplication:

Fundoplication is a safe surgery and complications are relatively uncommon. However they are still possible and may include:

• Infection in and around the surgical area
• Difficulty swallowing
• Abdominal pain
• Bleeding
• Accidental piercing of the esophagus, stomach, or other tissues during surgery

What can I expect after a fundoplication?

You will be given special diet instructions from your surgeon after fundoplication. You must follow these instructions closely to prevent complications. Remember to eat slowly, chew your food very well, eat only small bites, and do not drink any carbonated beverages.

You may experience difficulty swallowing (dysphagia) or abdominal bloating or pain (gas bloat syndrome). Both of these are symptoms are noted in most patients after this type of surgery. These symptoms will get better and normally last 2 – 6 weeks. Following your diet instructions will help minimize these symptoms by alerting you to foods that tend to be difficult to swallow or that distend your stomach.

You will have a weight restriction after surgery. This means you must not lift anything heavier than 10 pounds for 4 weeks after surgery. It is very important that you follow this weight restriction. Lifting heavy objects in the first 4 weeks after surgery will cause increased pressure on the surgical site and can cause the closed incision to re-open.

You will not be able to drive until you are off all narcotic pain medications and are able to safely maneuver the vehicle without discomfort.

You may feel occasional “twinges and pulls” at the incision sites. This is normal during the healing process. Ibuprofen (if you are able to take) or acetaminophen usually work best for relieving this type of discomfort.

You may have some shoulder discomfort after surgery for the first few days from nerves in the diaphragm being “irritated.” Walking and using NSAIDS (if you are able to take) work well for relieving this pain.

You must stay hydrated. Sip liquids throughout the day between your “meals” (which may be your Protein Drinks). You know you are drinking enough liquids when your urine is a light yellow color.

Easing Post-Procedure Symptoms

It is common to have some swelling and bruising at your incision sites. This will resolve on its own with time. To ease symptoms in the first 24-48 hours after surgery, wrap an ice pack in a towel (to protect your skin) and apply it to incision sites or to swollen/bruised areas. Do not leave ice on your skin for longer than 20 minutes (20 minutes on , 40 minutes off every hour as needed).

After post-op day 3 (the day after your surgery is post-op day 1), you may begin to use a warm (not hot) heating pad to help with the muscular discomfort. Always protect your skin with a towel and do not leave heat on the area for an extended period of time.

Walk! Walking eases discomfort and helps blood flow to your tissues to help with healing. As long as you stay within your restricted weight limits, you should be moving around, going up-and-down stairs, and living as normal as you are able.

Constipation is not uncommon after surgery, especially if you are taking narcotic pain medication. Please take a stool softener when you get home from the hospital (any over the counter one that works for you). Continue to take this every day until you are back to your normal bowel habits. If you have not had a bowel movement by the 5th day after surgery, you may take a laxative like Miralax or Milk of Magnesia. Follow the instructions on the bottle.

If you have loose stools, do not take stool softeners or laxatives. For diarrhea, you may take Imodium (over-the-counter) as directed on the bottle.

Dressings

• Your surgical incision has either (purple) surgical glue, clear plastic (Tegaderm), or paper strips (Steri-strips) over it. It is ok to shower 24 hours after the surgery. While in the shower, DO NOT scrub the dressing. Instead, allow clear water to flow over it and gently pat it dry with a clean towel.
• Surgical glue may peel off on its own between 7 and 10 days after surgery. If the glue is still on at your postoperative appointment, we will have you peel if off then.
• Steri-strips may begin to curl and loosen on their own. If this happens, it is normal. Leave them alone and do not remove them until between 7 and 10 days after surgery.
• If you have a Tegaderm (clear) dressing, you may remove it 48 hours (2 days) after surgery, unless your surgeon has given you instructions otherwise.
• DO NOT soak in a tub, pool, spa, or any body of water until you are seen by the surgeon at your postoperative appointment.

Hernia Repair