What lifestyle changes (positive and/or negative) can be expected after laparoscopic surgery in a patient with Barrett's esophagus?
Response From the Expert
Brant K. Oelschlager, MD
Assistant Professor, Co-Director, Center for Videoendoscopic Surgery, Department of Surgery, University of Washington, Seattle; Director, Swallowing Center, University of Washington Medical Center, Seattle, Washington
Although laparoscopic antireflux surgery may potentially have benefits with regard to the natural history of the intestinal metaplasia of Barrett's esophagus, the data are conflicting and, therefore, most patients considering surgery should do so for improved control of gastroesophageal reflux disease (GERD) symptoms. The advantage of surgery over medical therapy alone for Barrett's esophagus is superior GERD symptom control, with the vast majority of surgical patients experiencing a substantial improvement over those receiving medical therapy alone. In our series, this improvement is greater than 95% for typical symptoms of GERD, such as heartburn, and most patients stop proton-pump inhibitor therapy.
The negative effects should be few (in expert hands). Most patients experience some mild dysphagia in the first 4-6 weeks after operation. This routinely resolves with time, and very few patients have persistent or recurrent dysphagia. When dysphagia persists/recurs, it is usually associated with poor construction of the fundoplication or recurrent hiatal hernia. The most common side effect or complaint after surgery is postprandial bloating; this occurs in a minority of patients and is usually mild and thought to be multifactorial. Many patients with GERD have delayed gastric emptying at baseline, and adding an antireflux procedure decreases the ability to belch and release gases through the esophagus. The other associated side effect occasionally experienced after surgery is hyperflatulence; this is usually mild and transient and thought to be because of chronic air swallowing. Hyperflatulence is common in patients with GERD because of the inability to belch these gases in a retrograde fashion.
It should be noted that the results with antireflux surgery vary with experience and expertise, and symptomatic improvement of GERD is much more common with surgeons who have a great deal of experience with esophageal disorders and minimally invasive esophageal surgery. Barrett's esophagus is associated with more severe degrees of GERD. Many of these patients will have poor symptomatic response to medical therapy and will therefore seek alternatives. For most of these individuals, laparoscopic antireflux surgery is an excellent alternative to medical treatment.