What is fundoplication?
Fundoplication is the standard surgical method for treating gastro-esophageal reflux disease (GERD). GERD causes inflammation, pain (heartburn), and other serious complications (such as scarring and stricture) of the esophagus. GERD results when acid refluxes (regurgitates, or backwashes) from the stomach back up into the esophagus. Under normal conditions, there is a barrier to reflux of acid. One part of this barrier is the lower-most muscle of the esophagus (called the lower esophageal sphincter).
Most of the time, this muscle is contracted (constricted, or tight), which closes off the esophagus from the stomach. In patients with GERD, the sphincter does not function normally. The muscle is either weak or relaxes inappropriately. Fundoplication is a surgical technique that strengthens the barrier to acid reflux when the sphincter does not function normally.
Why It Is Done
Fundoplication surgery is most often used to treat GERD symptoms that are likely to be caused in part by a hiatal hernia and that have not been well controlled by medicines. The surgery may also be used for some people who do not have a hiatal hernia. Surgery also may be an option when:
- Treatment with medicines does not completely relieve your symptoms, and the remaining symptoms are proved to be caused by reflux of stomach juices.
- You do not want or, because of side effects, you are unable to take medicines over an extended period of time to control your GERD symptoms, and you are willing to accept the risks of surgery.
- You have symptoms that do not adequately improve when treated with medicines. Examples of these symptoms are asthma, hoarseness, or cough along with reflux.
Risks or complications following fundoplication surgery include:
- Difficulty swallowing because the stomach is wrapped too high on the esophagus or is wrapped too tightly. This complication may be more likely to occur in people who receive fundoplication surgery using a laparoscopic surgical technique.
- The esophagus sliding out of the wrapped portion of the stomach so that the valve (lower esophageal sphincter) is no longer supported.
- Heartburn that comes back.
- Bloating and discomfort from gas buildup because the person is not able to burp.
- Excess gas.
- Risks of anesthesia.
- Risks of major surgery (infection or bleeding).
For some people, the side effects of surgery-bloating caused by gas buildup, swallowing problems, pain at the surgical site-are as bothersome as GERD symptoms. The fundoplication procedure cannot be reversed, and in some cases it may not be possible to relieve the symptoms of these complications, even with a second surgery.
What are the Types of Fundoplication Surgery?
This type of fundoplication surgery is most often performed. This surgery involves making five small incisions in the abdomen. One is used for the laparoscope, and the other four are for instruments to do the operation. Recovery time is only a few days in the hospital. A patient also experiences less pain, and less complications (such as wound infection).
Laparoscopic fundoplication may not be appropriate for some patients. For example, laparoscopic fundoplication may be more difficult in patients who have had previous upper abdominal surgery.
This surgery requires a larger incision, 6 to 10 inches, in the abdomen or the chest. The recovery time for this procedure usually requires a week or longer stay in the hospital. A patient can also experience more pain, and there is a greater risk of complications
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