Endoscopic Fundoplication, or not? Posted: 07-29-06 17:03pm
My brother is 23 years old and has severe
cerebral palsy, for the last few years he
has been complaining of stomach pains but
was not able to explain what sort of pains
as he also has limited speech. About two
years ago he became anaemic and was taken
into hospital. While he was there he had
an endoscopy and the test revealed that he
had severe grade 3 erosive/ulcerative
oesphagitis. To treat this he was given
lansoprazole, two years later he still has
not recovered and he is still suffering
from the same symptoms. The doctors have
said that nothing can be done about it and
to carry on taking the medication given.
After reading an article about endoscopic
fundoplication I am wondering whether my
brother would benefit from this. I am
very concerned as my brother is in a lot
of pain, which is also causing sleepless
nights and now he seems to have developed
laughter attacks which can go on for
hours…doctors have not been able to
diagnose this but the attack always occur
when he is pain. I would be grateful if
anyone could give any suggestions.
It seems that you brother is experiencing
gastro esophageal reflux disease (GERD).
Stomach acid goes up in to the esophagus
causing erosive oesophagitis and ulcers.
Traditionally, anti-acid medicines are
used to relieve symptoms. Although these
can help ease the symptoms sometimes, they
are not a long-term cure. If not treated
effectively, an infant or adolescent can
be reliant on anti acid medicines for long
periods of time. Because medication has
not proven successful in the long-term,
the next option is a surgical procedure
called 'Nissen Fundoplication'. This
involves an operation on the abdomen
through a reasonably large incision
(unless performed via keyhole surgery,
'laparoscopy). The top of the stomach is
wrapped around the esophagus (gullet) -
making it act like a valve and stopping
the reflux. The complication rate is
15-60% resulting in patients not being
able to 'burp', swallowing difficulties
and not being able to vomit. With a
viral-like vomiting illness this can cause
problems in itself. It should be a
permanent surgical correction, but between
10-30% of patients will need the procedure
to be repeated within 5 years.
However, there is now a new alternative
using the endoscope via the mouth. With
this new procedure - called 'Endoscopic
Fundoplication'- there are no abdominal
incisions at all and the operation is done
through the Endoscope - through the mouth
and it is easily repeatable if required at
a later date, or easily undone if
required. The Endoscopic Fundoplication
procedure is done under a general
anesthetic. Most patients are able to have
this done as a day case or as an overnight
stay. Following the operation, patients
are advised to limit physical activity for
the first 4 weeks and to avoid any contact
sport. Anti sickness medication is
required for 48 hours after the procedure
and patients are told to avoid lumpy food
for the first 4 weeks.
The long-term results of this procedure
indicate that of 31 people, 3 had to have
the procedure repeated at 1-3 years after
the operation and 2 required the surgical
fundoplication. Only 3 remain taking any
medication. No medication is usually
needed after the procedure and patients
are usually symptom free.
About those laughter attacks, you can
consult a neurologist; they are probably
caused by his preexisting
condition-cerebral palsy.
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