AND today’s news of an innovative technique to cure the gastroesophageal reflux, gastric system disease which according to recent epidemiological studies affects from 709 million to 1.03 billion people worldwide and only in Italy, according to the Istituto Superiore di Sanità, 1 person out of 3. The new goal has been reached fromIRCCS Galeazzi-Sant’Ambrogio Hospital in Milan (San Donato Group) which has implanted, for the first time in Lombardy, a device for the treatment of gastroesophageal reflux. The operation was completed by Professor Davide Bona, Head of the General Surgery Operative Unit, with his team.
Gastroesophageal reflux: symptoms
The gastroesophageal reflux it is a disorder characterized by the rising of the acidic contents of the stomach into the esophagus. The main symptoms are heartburn (heartburn), acidity, and regurgitation (the backflow of acidic material from the stomach into the throat or mouth).
Chest pain and excessive salivation are also very common. In the mildest forms, it is usually enough to change some eating habits and improve the lifestyle, adding targeted physical activity and not going to bed immediately after meals. In more serious cases, however, these “good practices” must be supplemented by a specific pharmacological treatment. Often its symptoms can be confused with those of other pathologies, or cause other ailments. Cough, sore throat, insomnia, bad breath, chest pain, asthmaare symptoms that often make the diagnosis late.
How the new anti reflux device works
Gastroesophageal reflux is caused by two pathophysiological mechanisms: the supradiaphragmatic ascent of the lower esophageal sphincter and the consequent modification of the angle of His, i.e. the acute angle between the left lateral wall of the esophagus and the gastric fundus which is fundamental in the mechanism of sphincter continence . The new implanted device acts on both of these components.
The latest generation device able to restore the normal anatomy of the oesophagogastric joint
«The therapy of choice for gastroesophageal reflux is certainly pharmacological, with the intake of proton pump inhibitors. However, in suitably selected patients, the surgical option represents a valid alternative. Next to the classic minimally invasive anti-reflux surgerywhich he recognizes in the fundoplication according to Nissen and anti-reflux plastic according to Toupet the “gold standard” of treatment, in recent years a line of research has developed in the field of implantable devices with the aim of obtaining a standardization of the surgical procedure. Guaranteeing the optimization of the results, reducing the side effects such as dysphagia, abdominal distension, difficulty in belching and vomiting», explains Professor Bona.
How the intervention takes place
The new technique tested at IRCCS Galeazzi-Sant’Ambrogio allows the His angle between the esophagus and stomach to be reconstructed using stitches in non-resorbable material, thus reconstituting one of the main mechanisms that contribute to the prevention of gastroesophageal reflux. The gastric fundus is then reinforced by creating a pocket on the anterior wall into which the spherical device made of biocompatible silicone.
The purpose of the device is to maintain the gastroesophageal junction in an intra-abdominal position blocking the supradiaphragmatic ascent of the esophageal sphincter lower during respiration. It is a definitive intervention which can be accessed by all patients suffering from gastroesophageal reflux with possible small sliding hiatal hernias. The only contraindication is to have previously undergone gastric surgery.
How long does it last
The operation, which lasts 45 minutes – 1 hour, requires general anesthesia and takes place in laparoscopy. The abdomen is inflated with carbon dioxide and five small incisions are made, exactly as with anti-reflux plastic, through which surgical instruments are inserted.
The first step involves the isolation of the esophagus which is repositioned in the abdomen, then we proceed with the closure of the diaphragmatic pillars, subsequently the angle of His is reconstructed and the device positioned. No drainages are needed and the patient, having spent one night in the hospitalis discharged home and can immediately resume daily habits.
Gastroesophageal reflux: an innovation that improves life
«This innovative procedure therefore acts by reconstituting the physiological mechanisms pertaining to the esophagogastric joint by blocking the reflux of acid material into the esophagus. This intervention therefore goes to broaden the choices available to the surgeon with a view to developing a more and more “tailored” surgeryi.e. tailor-made for each individual patient», concludes Professor Bona.
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