Editing Anti-reflux surgery (section)

== '''Post-op management''' ==

* Clear fluids day 0
** NGT not used routinely
** Minimise opioids, give      anti-emetics
* Free fluids day 1
** Some say get a barium      swallow day 1
* Pureed diet day 2 and     continue for 2/52
* Soft diet 2/52 post-op
* Aim full diet 6/52 post-op
* Stop PPI after 1-6/52
** Hann stops after 1/52
** Janine seems to base on      symptoms
** Take level of Barrett's into      account - if they have Barrett's, need to continue it
* Dysphagia
** Most patients get it - give      mostly liquids somewhere between 2-12 weeks
** Early dysphagia is thought      to be due to post-operative oedema or even suture haematoma in stomach      wall
** If dysphagia persists after      12 weeks (3% of patients) or patient can't tolerate enough liquids to get      home - get a barium swallow to assess the fundoplication
*** Could be due to overtight       wrap, slippage or reherniation
*** Overtight wraps can be       endoscopically dilated starting 6/52 post-op
*** If barium swallow looks ok,       empiric dilatation of GOJ should be performed
* Gas bloat syndrome -     inability to burp, leads to distension
** Can do CXR/AXR to confirm      gastric distension
** Usually self-limiting and      subsides by 3/12 mark, but can consider endoscopic dilatation
** Occasionally needs a post-op      NGT