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The stomach is an organ that is located in the hollow organs of the digestive system, starts after the esophagus and continues with the duodenum, and acts as a reservoir and digestion for the objects we eat . It is located in the abdominal cavity. Thanks to the digestive enzymes secreted from its wall, it is especially involved in the digestion of proteins. It is adjacent to the diaphragm, left half of the liver, spleen, pancreas, omentum, and the middle part of the large intestine.
Stomach contents are acidic. This is necessary for the enzyme pepsin, which is secreted to digest proteins, to function. Fluids and tissues in other parts of the body are neutral, not acidic. Acidic environments damage organs and tissues under normal conditions, but the stomach is resistant to acidic environment thanks to the structure of the tissue cover that covers its inner surface, called the mucous membrane. At the entrance and exit of the stomach, there are clamp mechanisms that prevent the uncontrolled passage of gastric fluid into the esophagus (lower esophageal sphincter) and duodenum (pylorus). While the pylorus controls the gastric emptying rate, the gastroesophageal sphincter prevents the acid contents of the stomach from escaping back into the esophagus and irritating it. It provides this function through the thickened muscle layer in this region and the anatomical angle (His angle) between the stomach and the esophagus. Often, due to the deterioration of the His angle (stomach hernia), the order is disturbed and the stomach contents come into contact with the esophagus more than it should. This condition is called gastroesophageal reflux disease.
As a result of the development of reflux, patients complain of bitter water coming into the mouth and burning behind the breastbone. Since these complaints increase reflux, they become more evident especially after going to bed at night. In addition to the complaints, changes occur in the inner surface of the esophagus. Irritation and inflammation (esophagitis) may develop in the esophagus due to the presence of reflux, as well as the change in the structure of the tissue (mucosa) on the inner surface of the esophagus to the mucosa in the intestine (Barrett's esophagus). Barrett's esophagus is not cancer, but it can turn into cancer over time if it is not diagnosed, followed and treated.
Reflux can be controlled with medication. Patients who benefit from drug therapy also benefit greatly from surgery. The effect of surgery is also limited in patients who are unresponsive to drug therapy or who have limited benefit. Since proton pump inhibitors, one of the stomach drugs, may have some negative effects (increase in the risk of Alzheimer's disease, etc.) in the long term, patients who cannot continue their life without these drugs are the most suitable candidates for surgery. Apart from typical reflux complaints (bitter water in the mouth, burning in the chest), patients with complaints (chronic cough, hoarseness, bad breath, etc.) will have limited benefits from the surgery. Therefore, it is necessary to be careful and meticulous in the selection of patients for surgery.
Since the problem is caused by a gastric hernia, this hernia is surgically repaired, often using a synthetic patch, and reflux is prevented by re-establishing the His angle. Existing esophagitis regresses, but Barrett's esophagus does not. However, since the cause of Barrett's esophagus is eliminated, progress is expected to stop and regular controls are continued. If there is a suspicion of progression or cancer in Barrett's esophagus during the controls, treatments and (if necessary) surgeries are applied for Barrett's esophagus, not reflux this time.
Surgical treatment of Reflux Disease is performed by closed surgery (laparoscopically). In the initial part of the stomach, the pocket-shaped part called fundus is released, wrapped around the esophagus and fixed with sutures in place. This surgery is called Laparoscopic Fundoplication. There are different types such as Nissen, Toupet and Dorr, nowadays mostly Toupet fundoplication is used.
Endoscopy is essential for the diagnosis of the disease. Gastric hernia is seen with endoscopy, and esophagitis or Barrett's esophagus, if present, is detected. Afterwards, pH measurement is made by measuring the acidity level in the esophagus and the presence of reflux is confirmed.
Surgery preparations are completed with simple blood tests and anesthesia examination. Patients spend 1 or 2 days in the hospital after surgery and go home. Patients who start to be fed with water on the first day switch to normal nutrition in a short time.
Sometimes difficulty swallowing or vomiting may occur after surgery. These problems are temporary and disappear over time.