Fundoplication

Surgical procedure to treat gastroesophageal reflux disease (GERD), which is also called acid reflux and 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 and into the chest cavity; this increases the severity of GERD.

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

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
  • The night before, eat a light meal and do not eat or drink anything after midnight
During Procedure - IV fluids, anesthesia, urinary catheter

Anesthesia - General

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 (e.g., Nissen fundoplication). These include: obesity, bleeding problems, and dense scar tissue from a previous surgery.

After Procedure - Youll need to follow a liquid diet at first

How Long Will It Take? Several hours

Will It Hurt? Anesthesia prevents pain during surgery. Youll likely have some discomfort during recovery, but youll 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 re-operation
Average Hospital Stay:

Nissen fundoplication/open procedure: 2-4 days

Laparoscopic procedure: 2 days (or more, depending on your condition)

Postoperative Care:
  • Walk with assistance the day after surgery
  • Keep the incision area clean and dry
  • Youll 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; from laparoscopic surgery, two weeks. The procedure may need to be repeated if the wrap was too tight, if 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