Fundoplication

Definition

Surgical procedure to treat gastroesophageal reflux disease (GERD), which is also called acid reflux or heartburn. A hiatal hernia, if present, may also be fixed during this procedure. A hiatal hernia occurs when a portion of the stomach pokes through an opening in the diaphragm (muscel that separates chest and abdominal cavity). This hernia increases the chance and severity of GERD.

Fundoplication

Fundoplication

© 2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

  • Abdomen
  • Stomach
  • Esophagus
  • Diaphragm, possibly

Reasons for Procedure

Fundoplication is used to treat problems related to GERD. The procedure is most often performed for the following reasons:

  • Eliminate persistent symptoms that are not relieved by medication
  • Correct a condition contributing to asthma symptoms
  • Repair a hiatal hernia, which may be responsible for making GERD symptoms worse
  • Eliminate the source of serious, long-term complications resulting from too much acid in the esophagus (swallowing tube)

Risk Factors for Complications During the Procedure

  • Pre-existing heart or lung condition
  • Obesity
  • Prior upper abdominal surgery
  • Recent or chronic illness
  • Diabetes
  • Prematurity (in babies)
  • Neurologic abnormalities

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • X-rays
  • Endoscopy—use of a tube attached to a viewing device (an endoscope) to examine the inside of the body

The day before and day of your procedure:

  • Review your regular medications with the surgeon; you may need to stop taking some.
  • Arrange for a ride to and from the hospital.
  • For the night before, eat a light meal and do not eat or drink anything after midnight.

During Procedure

IV fluids and anesthesia will be administered. A urinary catheter will be placed.

Anesthesia

General anesthesia will be given.

Description of the Procedure

There are two methods used to perform a fundoplication, an open surgical procedure and a laparoscopic procedure.

Nissen Fundoplication/Open Procedure

The surgeon makes a wide incision to expose the stomach and lower esophagus. The surgeon wraps the upper portion of the stomach around the esophagus to create pressure on the sphincter muscle at the bottom of the esophagus. If a hiatal hernia exists, the doctor positions the stomach back in the abdomen and tightens the diaphragm.

Laparoscopic Procedure

The doctor makes a small incision and inserts a laparoscope, which is a thin, flexible instrument that lights the area and allows the doctor to view the inside of the body on a screen. Gas is pumped into the abdomen to improve viewing. Other, small incisions are made in the skin in order to insert the surgical instruments. Using these instruments, the doctor wraps the stomach around the esophagus and, if needed, repairs the hernia.

Certain conditions may complicate a laparoscopic procedure, causing the surgeon to switch to an open approach (eg, Nissen fundoplication). These include: obesity, bleeding problems, and dense scar tissue from a previous surgery.

After Procedure

You'll need to follow a liquid diet at first.

How Long Will It Take?

The procedure typically takes several hours.

Will It Hurt?

Anesthesia prevents pain during surgery. You'll likely have some discomfort during recovery, but you'll be given medications to relieve this pain.

Possible Complications

  • Infection
  • Difficulty swallowing
  • Excessive bleeding
  • The return of reflux symptoms
  • Delayed intestinal functioning or bowel obstruction
  • Limited ability to burp or vomit
  • Gas pains
  • Injury to the esophagus, spleen, or stomach
  • Anesthesia-related problems
  • Pain, requiring you to be on a liquid diet for an extended period of time
  • A wrap that is too loose or too tight, hernia, or recurrent ulcers requiring reoperation

Average Hospital Stay

Nissen fundoplication/open procedure: 2-4 days

Laparoscopic procedure: two days or more, depending on your condition

Postoperative Care

  • Walk with assistance the day after surgery.
  • Keep the incision area clean and dry.
  • You'll start with a liquid diet and gradually progress to solids.
  • Once you can tolerate solid foods, eat slowly.

Outcome

Recovery from an open procedure takes about six weeks, and about two weeks from laparoscopic surgery. The procedure may need to be repeated if the wrap was too tight, the wrap slips, or if a new hernia develops. After a successful fundoplication, you may no longer need to take medication for GERD.

Call Your Doctor If Any of the Following Occurs

  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough, shortness of breath, chest pain, or severe nausea and vomiting
  • Signs of infection, including fever and chills
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • Pain not relieved by medication
  • Difficulty swallowing after the first few weeks

RESOURCES:

National Digestive Diseases Clearinghouse
http://digestive.niddk.nih.gov

The Society of American Gastrointestinal and Endoscopic Surgeons
http://www.sages.org

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index_e.html

The Canadian Association of Gastroenterology (CAG)
http://www.cag-acg.org/default.aspx

References:

Society of American Gastrointestinal Endoscopic Surgeons website. Available at: http://www.sages.org/ .

The Society of Thoracic Surgeons website. Available at: http://www.sts.org/sections/aboutthesociety/practiceguidelines/antibioticguideline/ .



Last reviewed February 2008 by Daus Mahnke, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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