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Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

Fundoplication is a surgery on the stomach and esophagus. It is done to treat gastroesophageal reflux disease (GERD). GERD is also called acid reflux or heartburn. This occurs when acid from the stomach goes up the esophagus. A hiatal hernia may also be fixed during the procedure. This type of hernia occurs when a portion of the stomach pokes into the chest cavity. This hernia increases the chance and severity of GERD.

Fundoplication

Fundoplication
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Reasons for Procedure

The surgery is most often done for the following reasons:

  • Eliminate persistent GERD symptoms that are not relieved by medicine
  • Correct acid reflux that is 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

Possible Complications

If you are planning to have fundoplication, your doctor will review a list of possible complications, which may include:

  • Infection
  • Bleeding
  • Difficulty swallowing
  • Return of reflux symptoms
  • Limited ability to burp or vomit
  • Gas pains
  • Damage to organs
  • Anesthesia-related problems

In rare cases, the procedure may need to be repeated. This may happen if the wrap was too tight, the wrap slips, or if a new hernia forms.

Some factors that may increase the risk of complications include:

  • Pre-existing heart or lung condition
  • Obesity
  • Smoking
  • Diabetes
  • Prior upper abdominal surgery

What to Expect

Your doctor may do the following:

  • Physical exam
  • X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones
  • Endoscopy —use of a tube attached to a viewing device (an endoscope) to examine the inside of the lining of the esophagus and stomach; a biopsy may also be taken
  • Manometry—a test to measure the muscular contractions inside the esophagus and its response to swallowing

Leading up to the surgery:

  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Anti-inflammatory drugs (eg, aspirin )
    • Blood thinners, like warfarin (Coumadin)
    • Clopidogrel (Plavix)
  • Arrange for a ride to and from the hospital. Also, arrange for help at home.
  • The night before, eat a light meal. Do not eat or drink anything after midnight.

General anesthesia will be used. It will block any pain and keep you asleep through the surgery.

A wide incision will be made in the abdomen. This is to expose the stomach and lower esophagus. The doctor will wrap the upper portion of the stomach around the esophagus. This will create pressure on the lower part of the esophagus. It will prevent stomach acid from moving up the esophagus. If a hiatal hernia exists, the stomach will be placed entirely back in the abdomen. The doctor will then tighten the opening in the diaphragm where the hernia poked through.

2-4 hours

You will have discomfort during recovery. Ask your doctor about medicine to help with the pain.

2-4 days

  • Walk with assistance the day after surgery.
  • Keep the incision area clean and dry.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • You will start by eating a liquid diet. You will slowly be able to eat more solid foods.
  • After a successful fundoplication, you may no longer need to take medicines for GERD.
  • Be sure to follow your doctor's instructions .

It will take about six weeks to recover.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Increased swelling or pain in the abdomen
  • Difficulty swallowing that does not improve
  • Pain that you cannot control with the medicines you have been given
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
  • Cough, shortness of breath, or chest pain
  • Any other new symptoms
In case of an emergency, call for medical help right away.

RESOURCES:

National Digestive Diseases Clearinghouse

http://digestive.niddk.nih.gov/

The Society of American Gastrointestinal and Endoscopic Surgeons

http://www.sages.org/

CANADIAN RESOURCES:

The Canadian Association of Gastroenterology

http://www.cag-acg.org/

References:

EsophyX receives FDA clearance for performing transoral incisionless fundoplication surgery. Medical News Today website. Available at: http://www.medicalnewstoday.com/articles/83410.php. Published September 24, 2007. Accessed August 19, 2009.

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/.

Transoral incisionless fundoplication with EsophyX. Endogastric Solutions website. Available at: http://www.endogastricsolutions.com/esophyx_for-pt.htm. Accessed August 19, 2009.

Treating GERD. Ohio State University Medical Center website. Available at: http://medicalcenter.osu.edu/patientcare/healthcare_services/digestive_disorders/gerd_heartburn/diagnosing_treating_gerd/treating_gerd/Pages/index.aspx. Accessed August 19, 2009.

Last reviewed September 2012 by Marcin Chwistek, 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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