Keyhole (laparoscopic) surgery for acid reflux disease is a safe procedure. However, there are potential risks involved in any form of surgery and we believe that it is important that you are aware of these.
Damage to the spleen.
During the part of the operation discussed earlier, the small blood vessels between the spleen and the upper part of the stomach (fundus) are cut using special instruments that seal the blood vessels before they are divided. However, sometimes damage to the spleen can occur. Frequently this can be controlled simply using the keyhole method, however, if the spleen were to sustain more severe injury this may require conversion to an open cut operation with the potential of removal of the spleen.
Damage to the oesophagus.
When the oesophagus is being freed up inside your abdomen there is a risk that it can be damaged. If this is seen at the time of the operation it can be repaired simply and the operation will be completed using the keyhole method, or it may mean you need to stay in hospital for a slightly longer period of time to ensure that it heals up well.
Severe swallowing difficulty.
While we expect you to notice that things go down more slowly after your operation, a few patients experience severe problems with swallowing in the first few days after their operation. If this occurs, it may be necessary to perform a second keyhole operation to loosen or remove some of the stitches we have put in. Rarely, some patients find it difficult to burp – this is called gas bloat syndrome.
Wound infection.
These are rare with keyhole surgery and if they do occur can be treated simply with antibiotics.
Damage to other organs inside your abdomen.
This is a rare complication of keyhole surgery but it has been recognised that during the insertion of instruments into the abdominal cavity damage can occur to any other intra-abdominal organs, including the intestine, liver and blood vessels. If this were to occur then it is likely that the approach to the operation would have to be changed from a keyhole approach to an open approach.
Chest infection.
Because you are relatively comfortable and able to easily mobilise after the operation, chest infections are rare. If a chest infection did occur it could be treated with antibiotics.
Deep vein thrombosis (DVT) and pulmonary embolus.
All surgery carries varying degrees of risks of thrombosis (clots) in the deep veins of your leg. In the worst case, a clot in the leg can break off and travel to the lung (pulmonary embolism). This can significantly impair your breathing. To prevent these problems around the time of your operation and following your operation we give you some special injections to ‘thin’ the blood. We also ask you to wear compression stockings on your legs before and after surgery and also use a special device to massage the calves during the surgery. Moving about as much as you can, including pumping your calf muscles in bed or sitting out of bed as soon as possible reduces the risk of these complications.
Conversion to an open operation.
We always warn people who are undergoing a keyhole procedure that there is a small risk that if the operation is technically not possible to complete through a keyhole technique we will make an open cut. If this is necessary, it will result in a larger scar and more post-operative discomfort and, inevitably, a longer stay in hospital.
Scarring.
Any surgical procedure that involves making a skin incision carries a risk of scar formation. A scar is the body’s way of healing and sealing the cut. It is highly variable between different people. All surgical incisions are closed with the utmost care, usually involving several layers of sutures. The sutures are almost always dissolvable and do not have to be removed. The larger an incision the more prominent it will be. Despite our best intentions, there is no guarantee that any incision (even those only 1-2 cm in length) will not cause a scar that is somewhat unsightly or prominent. Scars are usually most prominent in the first few months following surgery, however, tend to fade in colour and become less noticeable after a year or so.
Requirement for re-operation.
It is unlikely (5%), although possible, that some time after the operation you may need a further procedure related to the fundoplication. This is because it is possible for things to move slightly inside or for sutures to give way. If this is the case this may need to be corrected with another operation to revise the fundoplication. In very rare cases coughing, heaving or vomiting in the first few days after the operation can cause things to move or a suture to give way. This then may require another operation to correct things.
Other complications.
We have tried to describe the most common and serious complications that may occur following this surgery. It is not possible to detail every possible complication that may occur following any operation. If another complication that you have not been warned about occurs, we will treat it as required and inform you as best we can at the time. If there is anything that is unclear or risks that you are particularly concerned about, please ask.
Following discharge.
You will be given a copy of your discharge summary.
What are the risks of general anaesthesia?
In modern anaesthesia, serious problems are uncommon. Risks cannot be removed completely, but modern equipment, training and drugs have made it a much safer procedure in recent years. The risk to you as an individual will depend on; whether you have any other illness, personal factors (such as smoking or being overweight) or surgery which is complicated, long or done in an emergency. Please discuss any pre-existing medical condition with your anaesthetist.
Very common and common side effects (1 in 10 or 1 in 100 people)
- Feeling sick and vomiting after surgery
- Sore throat
- Dizziness
- Blurred vision
- Headache
- Itching
- Aches, pains and backache
- Pain during injection of drugs
- Bruising and soreness
- Confusion or memory loss
Uncommon side effects and complications (1 in 1000 people)
- Chest infection
- Bladder problems
- Muscle pains
- Slow breathing (depressed respiration)
- Damage to teeth, lips or tongue
- An existing medical condition getting worse
- Awareness (becoming conscious during your operation)
Rare or very rare complications (1 in 10,000 or 1 in 100,000)
- Damage to the eyes
- Serious allergy to drugs
- Nerve damage
- Death
- Equipment failure
After the procedure
- The operation aims to increase the pressure of the valve mechanism at the lower end of your oesophagus
- You will, therefore, notice that in the first few weeks after your operation it is more difficult to swallow food than it was before your operation. This is entirely normal and advice is given later on in this information sheet as to the type of food you should be eating during this period.
- You need to be very careful about eating foods of a coarser texture, such as bread or red meat. If these are eaten too quickly or too large a mouthful is swallowed they may become stuck in the lower end of the oesophagus.
- Because the valve has been tightened it is difficult for patients to belch and this can lead to painful trapped wind. In a similar manner, it is also difficult for patients to be sick. All these symptoms do improve with time, but it is important that you avoid precipitating these symptoms as much as possible in the early post-operative period.
- Approximately 50% of the patients who have this operation notice that they pass more wind through their bottom after the operation. Simple medications that absorb gas can be obtained over the counter at a chemist.
