RefluxStop is an implant that is used as part of a laparoscopic (keyhole) anti-reflux surgical procedure for patients with a hiatus hernia, that hernia will usually be repaired as part of the same procedure.
The purpose of the RefluxStop™ implant is to restore the natural function of the lower oesophageal sphincter (LOS). This is achieved because RefluxStop™ prevents the LOS from sliding up from its natural position in the abdomen into the chest.
The procedure is undertaken as an inpatient procedure and most patients will be listed as day cases, meaning they can go home on the same day they have their surgery.
Your consultant surgeon will determine your eligibility for RefluxStop based on a number of diagnostic tests that they will request and then review with you at consultation. The pros and cons of the procedure will have been explained before you go ahead and you will have signed a consent form.
Swallowing
Swallowing may get worse a few weeks after surgery
A few weeks after surgery (generally 2-4 weeks), scar tissue temporarily thickens and this is when most of the healing process occurs. Swallowing may become more difficult during this time. Be sure to swallow small bites every few hours while you are awake.
Please let us know if you are not able swallow yogurt consistency foods. Swallowing should slowly improve after 6 weeks. It can take some patients a few months to get back to “normal” though.
Everyone is different and while it is usual to experience swallowing problems some people have much less problem than others and it can be very unpredictable as to who will and who won`t.
So, while these guidelines will be appropriate for most people some will be able to accelerate back to normal food quicker and some slower.
Swallowing tablets
You may take your normal prescription medications. It is sometimes helpful to take them with yogurt or apple sauce instead of water. If you are still having problems swallowing them, you can check with your pharmacist and see if you can crush or break them. Hold off on large vitamins or supplements until you are swallowing without difficulty.
Exercise and other activities
In general, you may resume normal non-strenuous activities as soon as you are up to it. Aerobic activities are tolerated as long as you can speak in full sentences. If you cannot complete a full sentence without taking a breath, you are working too hard. You should not lift anything heavy (anything you have to strain to lift) for 1 month after surgery.
Chest and shoulder pain
Sometimes patients will experience shoulder pain or deep pain in the chest after surgery. This is due in part to the gas used at laparoscopy, but more so to the sutures placed in the diaphragm muscle; and should gradually resolve. Heat applied to the shoulders tends to help this pain the best. It may be difficult/uncomfortable to take a deep breath or lie flat immediately after surgery as breathing uses the diaphragm muscle. This will slowly improve as you heal from surgery. Doing slow deep meditation type breathing will help with recovery.
Pain medication
You may be given a prescription for a narcotic pain relief and /or anti-inflammatory and anti-nausea medication. Please speak to the Pharmacist at the hospital if you have any queries prior to your discharge. You may resume other medications you were on prior to surgery, unless otherwise informed by your surgeon. Your surgeon will be able to advise you whether to discontinue any heartburn medication.
Incision
You will have typically 5 small incisions between your belly button and your rib cage. The incisions can be closed in a number of ways with an absorbable stitch, surgical skin glue or steristrip (paper suture), Generally these will be covered with a water-resistant dressing of some sort. You may shower or bathe, but you should avoid getting the wounds wet for 48 hours. Avoid placing oil lotions on the glue and it will gradually peel off over time. Sometimes a swelling and/or a lump under the incision will develop and is part of the natural healing process; you need not be alarmed unless there is drainage more than a Band-Aid will handle. Bruising may occur here too. Prior to your discharge from hospital the nurses will provide you with wound care instructions on your discharge.
When to seek urgent help
Contact us in the following situations:
Fever over 38.6ᵒ, continuous vomiting, significant inability to swallow fluids of yogurt-consistency foods (see section above on swallowing), unusual chest or leg pain, increasingly red or hot incisions.
Hiccups
Hiccups are most often due to fluid and/or food that has not passed out of the oesophagus. Typically, they will stop in a few minutes. Wait until the hiccups have passed before resuming oral intake.
Saliva
If you find that you are regurgitating saliva or liquids, this is usually due to their building up in the oesophagus. Especially saliva (foamy stuff) has a hard time being cleared by the oesophagus. Saliva and liquids tend to build up between meals and before going to bed.
Spasm
Some patients experience spasm (chest tightness that can take your breath away) during the recovery period. Typically, this will last a minute or so. Spasm is most often due to food getting stuck in the lower oesophagus though sometimes will occur spontaneously. Although it can be very uncomfortable, it is not serious, and the frequency and severity will decrease as time goes by. If after 4 weeks you are having spasms every time you eat, please make an appointment to see us, or at least contact our office by phone or email to let us know.
Regurgitation or heartburn
Some patients will feel heartburn symptoms after surgery. It is very unlikely this is due to reflux. Heartburn can occur with oesophageal irritation of any type including surgery – not just acid reflux. Regurgitation during the recovery phase is reflux of fluid within the oesophagus, and not from the stomach. Don’t be alarmed if this happens, it should resolve as the swelling goes down and swallowing improves. It is very unlikely you should need acid-suppressive reflux medications after surgery. If in the future someone wants to prescribe reflux medications for you, or you are concerned your reflux is back, please let us know. We strongly recommend a pH test to document reflux prior to starting on reflux medications, especially after surgery.
Frequently asked Questions and Answers
Q: What reflux could I expect after the procedure?
A: Acid reflux is expected to disappear shortly after surgery.
Q: How fast am I back on my feet?
A: Depending on local practice, patients can usually go home the same day as surgery. After a week you should normally have completely recovered.
Q: When can I eat normally again?
A: The first day after surgery you will usually follow a liquid diet and thereafter you can start to eat normally again.
Q: Will I have difficulties swallowing?
A: The food passageway is not restricted by the surgery with RefluxStop™ and therefore swallowing is unimpeded. If you experienced swallowing problems before the surgery, there is a high likelihood that such swallowing problems will diminish or disappear, according to the experience of the RefluxStop™ clinical trial.
Q: Some patients find that they can become constipated following surgery, is this normal?
A: Some patients become constipated and need to take either natural or medical laxatives if their bowels have not opened. Constipation can cause quite a lot of discomfort and pain especially if you have not had a bowel movement for three or more days.
- Constipation can be caused by the pain relief medication that people are prescribed, however most people find that using an over-the-counter laxative will be sufficient to remedy the situation.
- If an over-the-counter medication is not sufficient to rectify the situation, please seek the advice of your GP or call the RefluxUK office for a prescription for a stronger laxative.
Q: Will I have problems vomiting?
A: The ability to vomit is normally not affected with RefluxStop™.
Q: What are the results of the RefluxStop™ procedures?
A: The results from the clinical trial are excellent, but there always remains a small risk that an implant, or any surgical procedure, might not or may only partially produce its intended effect.
Q: What is the likelihood that the implant will break in the long-term?
A: RefluxStop™ TM is made of solid medical grade silicone and therefore has a high probability to last for life.
Q: Can I feel the implant in my everyday life?
A: No – you do not feel the implant.
Q: I’ve heard that other procedures could affect the ability to belch. Will RefluxStop™ TM also affect belching?
A: Since RefluxStop™ does not constrict or confine the food passageway as opposed to other surgical methods,
belching should normally be unaffected.
Q: Once I have recovered from the surgery with RefluxStop™ TM, can I pursue my usual activities?
A: There are no restrictions.
Q: Do I have to show an implant passport at airport security?
A: This is not needed. The implant is free of metal or electronic components – in contrast to, for example, cardiac pacemakers. Therefore, there should be no problems with air travel.