Burning or “burning” behind the breastbone is used to describe what is known in medical terms as “heartburn” or gastroesophageal reflux (GER), i.e., stomach contents moving up into the esophagus because of a failure of the lower esophageal sphincter (LES), a valve that separates the esophagus from the stomach.
As gastric acid travels up the esophagus, it causes burning behind the breastbone, which can reach the neck. Other symptoms of GERD may include chronic coughing with hoarseness, frequent vomiting and chronic throat involvement (in fact, many patients are diagnosed at the ENT office).
Causes of Gastroesophageal Reflux Disease (GERD)
When eating, food passes from the mouth to the stomach through the esophagus. When the lower esophageal sphincter (a valve that separates the esophagus from the stomach preventing gastric juices from “rising” into the esophagus) is altered, gastric acids pass into the esophagus in an uncontrolled manner, producing GERD or Gastroesophageal Reflux Disease (GERD).
The causes of an alteration of the lower esophageal sphincter (LES) are multiple, the most frequent being a hiatal hernia. However, having a hiatal hernia does not mean that there will be GER; it is possible to have GER without hiatal hernia.
There are patients who by their constitution or birth have an alteration in the functioning of the LES; there are also external conditions that alter the LES, such as alcohol, tobacco, strenuous exercise, etc.
Gastroesophageal reflux treatment
To treat gastroesophageal reflux, three steps must be followed progressively:
- Changes in habitual life. Easy to digest meals should be eaten, avoiding at all times irritants such as alcohol, spicy foods, coffee and large meals. It is also advisable to do gentle exercise and raise the head of the bed 20 centimeters, because at night is when most episodes of reflux occur (we must never go to bed at the end of lunch or dinner, but we must wait 60-90 minutes for the “digestion” to take place).
- Treatment with medication
- Surgery. Those patients who do not respond to medical treatment or cannot follow it are subsidiaries of surgery since the pathology will be solved in 90% of the cases.
Advantages of treatment of reflux with laparoscopy
In the past, making an incision of 20-30 cm in the abdomen was the only way to operate this disease; today, by means of laparoscopic surgery, gastroesophageal reflux can be repaired by means of 4-5 incisions of 0.5-1 cm.
The main advantages of this technique are
- Less postoperative pain
- Shorter hospital stay
- Rapid tolerance to food
- Rapid establishment of bowel function
- Quicker recovery to normal activity.
- Better cosmetic results along with lower rate of hernias or wound problems.
Candidates for laparoscopy to treat gastroesophageal reflux.
Although laparoscopic Gastroesophageal Reflux Surgery has many advantages, it may not be appropriate for some patients, always consult with your surgeon to find out which is the most appropriate technique as there are certain cardiac, respiratory and neurological diseases that contraindicate laparoscopic surgery.
Preparation of the patient before a laparoscopy to treat gastroesophageal reflux
The day before the laparoscopy to treat gastroesophageal reflux, the patient will perform intense personal hygiene consisting of 2 showers. No dietary preparation is necessary other than fasting eight hours before surgery (taking only the medications indicated with a small sip of water if necessary). The patient must stop taking 5 days before the operation those drugs that alter blood clotting, such as Aspirin and derivatives, Sintrom and some anti-inflammatory drugs.
Laparoscopic surgery of the gastroesophageal reflux
The term laparoscopic surgery refers to the way in which the surgeon accesses the abdominal cavity. The abdomen is insufflated with gas (CO2) in order to introduce a TV camera into the abdomen along with the necessary instruments to perform the surgery. The intervention is performed by watching a monitor that shows the images of the camera introduced into the abdomen. The surgery is then performed and explained to the patient in the consultation room.
Postoperative period for gastroesophageal reflux surgery
The postoperative period of the operation will depend on the patient and the type of surgery; before being sent to the ward, the patient will pass through an intensive or medium surveillance unit.
After 24 hours, the patient will start drinking liquids and eating crushed food (if his tolerance is good); 48 hours after the operation, provided that the tolerance is correct, the patient will be discharged from the hospital. Then he/she will be able to do the exercises that the abdominal discomfort will allow him/her, recovering his/her normal life 5-7 days after the intervention.
The patient will be with food by Turmix for 10 days, going to consultation to remove stitches and giving the dietary pattern according to their evolution.
Risks of gastroesophageal reflux surgery
Complications in gastroesophageal reflux surgery are rare, but can occur (bleeding or infection, both inside and outside the abdomen).
Internal organs such as the spleen, colon, small intestine, etc. can also be injured. Thromboembolic phenomena can also occur, despite the use of preventive drugs.
It is important to recognize complications early in order to treat them as urgently as possible.
The surgeon should be called in the following cases:
- Fever above 38° or chills.
- Bleeding from wounds or from the rectum (the latter occurs in small amounts during the first days after the operation). – Increasing abdominal pain or swelling of the abdomen.
- Inability to urinate.
- Redness or oozing from any of the wounds.
- If you have respiratory symptoms such as persistent cough or rib pain.