Fundoplication Surgery for GERD
Fundoplication is a minimally invasive surgical procedure to correct a weak Lower Esophageal Sphincter or LES and reduce the symptoms and incidence of GERD. Typically, a fundoplication is performed when lifestyle and medication management has failed, and GERD remains under-treated or particularly severe.
The fundoplication is performed by wrapping the top of the stomach known as the fundus around the lower part of the esophagus to add pressure to the LES, thereby keeping it closed and preventing stomach juices from going upward into the esophagus. A Nissen fundoplication is a 360° wrap around the esophagus, while the Dor and Toupet fundoplications involve a partial wrap around the esophagus to address inherent shortcomings of the Nissen version of the fundoplication.
Any fundoplication can be employed for a sliding hiatal hernia, however a Nissen fundoplication is always performed for a paraesophageal hiatal hernia. Patients who have had a gastric sleeve cannot undergo a fundoplication since the fundus of their stomach is removed during the sleeve procedure.
How the Fundoplication Works
Four small incisions are made in the abdomen through almost exclusively using robotics. Specialized surgical tools, including a laparoscope are passed, to visualize the abdomen. The procedure is performed under general anesthesia. Your surgeon will take the top part of the stomach and wrap it around the lower part of the esophagus. The new structure is held in place with sutures.
This procedure can be performed using traditional laparoscopy or robotically assisted surgical techniques.
Aftercare
This procedure is an outpatient procedure. For about two weeks after surgery, the patient will have a modified liquid and soft solids diet to allow the stomach to heal. Normal activity can be resumed soon after surgery, once your surgeon has given the all clear.
Generally speaking, the Nissen fundoplication offers excellent results with most patients achieving complete improvement or elimination of the symptoms of GERD.
Risks of Fundoplication
The primary risks of a fundoplication are those inherent to any major surgical procedure including infection, blood loss, pain, hernia at incision sites, and very rarely death. Risks and consideration specific to the fundoplication itself may include:
- Discomfort, especially in the first few weeks after surgery while the stomach is recovering.
- Dysphasia, or difficulty swallowing is a common symptom. This is true during an adjustment period that can last a few weeks.
- A condition known as gas bloat syndrome. This is due to the added pressure on the lower esophageal sphincter keeping it closed. Partial fundoplications have made this more tolerable, but it remains a significant lifestyle impediment.
- Over time, the sutures can break and release the wrap which can cause a return of GERD.
- Rarely damage or puncture of the esophagus
- Slippage of the wrapped portion of the stomach
The LINX Reflux Management System, a small implanted titanium bracelet with a magnetic clasp was developed to offer many of the same benefits of a fundoplication with fewer potential risks and considerations. Learn more about the LINX system here.
References:
- Wendling MR, Melvin WS, Perry KA. Impact of transoral incisionless fundoplication (TIF) on subjective and objective GERD indices: a systematic review of the published literature. Surg Endosc. 2013 Oct;27(10):3754-61.
