What is laparoscopy?
The word "laparoscopy" means to look inside the abdominal cavity with a special camera or "scope" (called a laparoscope). During laparoscopy, five or six small incisions are made in the abdomen. Then, the abdominal cavity is inflated with carbon dioxide to lift the abdominal wall away from the organs below and provide an operating space in the abdomen.
The laparoscope and surgical instruments are inserted through the incisions. The surgeon is guided by the laparoscope, which transmits a picture of the abdomen on a video monitor so the procedure can be performed.
Patients who have laparoscopic antireflux surgery generally experience less pain and scarring after surgery, have a quicker recovery, and less risk of infection than those who have traditional antireflux surgery. (See the chart below)
- Laparoscopic antireflux surgery: Five 5-10 mm incisions in the abdomen
- Traditional antireflux surgery: Six-inch vertical incision from the sternum to the navel; frequently, surgical staples are used to hold the wound edges together
Length of Hospital Stay
- Laparoscopic antireflux surgery: Two days
- Traditional antireflux surgery: Five to six days
- Laparoscopic antireflux surgery:
- Less bleeding and scarring after surgery
- Less risk of infection after surgery
- No nasogastric tube needed
- Traditional antireflux surgery:
- Potentially more bleeding and scarring after surgery
- Greater risk of infection after surgery
- Nasogastric tube (tube that is placed through your nose and into your stomach to remove air and digestive juices from the stomach.
What happens before laparoscopic antireflux surgery?
A pre-surgical evaluation is first performed to make sure that laparoscopic antireflux surgery is the right treatment for you. The evaluation usually lasts about two days and is scheduled a few weeks before your surgery date.
During the evaluation, you will:
- Have a complete physical examination.
- Have several tests to make sure you are physically ready for the surgery. Depending on your age and general health, the tests might include a chest X-ray, lung function test, blood test, electrocardiogram (EKG), or other tests as ordered.
- Meet with several health care providers, including the surgeon, who will ask you questions about your condition and your health history.
- Meet with an anesthesiologist (a doctor who specializes in sedation and pain relief), who will discuss the type of pain medication (anesthesia) you will be given during surgery. You will also discuss the type of pain control after surgery.
- Have the opportunity to ask questions about the procedure.
You will need to follow a clear liquid diet for two days before surgery, as directed by your healthcare team. You may be given a prescription for a solution to take the day before surgery to properly cleanse the bowel. Your healthcare team will provide more detailed instructions to help you prepare for surgery.
What should I expect the day of surgery?
- Do not eat or drink anything after midnight the evening before surgery.
- Please do not bring valuables such as jewelry or credit cards.
- You will be told what time to report for surgery.
- You will be asked to change into a hospital gown and get into bed. You will be given a bag for your clothing. The person with you will be asked to take your personal belongings.
- An intravenous tube (IV) will be placed in your arm to deliver fluids and medication.
- You will be asked to remove contact lenses and dentures.
- A nurse might give you medicine through your IV to help you relax.
- Your family will wait in the family lounge. They will receive periodic reports about your progress throughout the surgery.
- Once the surgeon is ready for you, you will be taken to the operating room.
What happens during surgery?
- An anesthesiologist will inject medication into your IV that will put you to sleep.
- After you are asleep, the nurses will cleanse your abdomen with antibacterial soap and cover you with sterile drapes.
- The surgeon will make a small incision in your abdomen, through which a small sterile tube is passed. Through the tubing, carbon dioxide is passed into the abdominal cavity to lift the abdominal wall away from the organs below. This space provides your surgeon a better view and more operating space.
- The laparoscope, which is connected to a video camera, is placed through the small incision, made above your belly button. The images your surgeon sees in the laparoscope are projected onto video monitors placed near the operating table.
- Before starting the surgery, your surgeon will inspect your abdominal cavity to make sure that laparoscopy will be safe for you. Some reasons why laparoscopy might not be done include multiple adhesions (scar tissue), infection, or any unsuspected or widespread abdominal disease.
- If your surgeon decides that laparoscopic surgery can be safely performed, four to five additional small incisions will be made. Instruments called trocars and cannulas are inserted through the small incisions. These incisions will give your surgeon access to the abdominal cavity in order to perform the surgery.
- To correct GERD, the surgeon reduces the hernia (returns the stomach into the abdomen), and wraps the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This reinforces the lower esophageal sphincter so that food will not reflux back into the esophagus.
- Finally, your surgeon will check that there are no areas of bleeding, rinse out the abdominal cavity, and close the small incisions.