Fundoplication is a surgical procedure that helps treat some gastroesophageal conditions.
During a fundoplication for gastroesophageal reflux disease (GERD), for example, a surgeon will attach part of the stomach to the lower esophageal sphincter, which helps reduce acid reflux.
That said, fundoplication treatment is not a replacement for other ways to control GERD, such as making dietary and lifestyle changes. In fact, doctors usually reserve this procedure for people who do not get symptom relief with less invasive treatments.
Fundoplication is the standard surgical treatment to manage GERD. There are some general things to expect during the process, and doctors will have specific instructions in each case.
Learn more about fundoplication in this article.
Fundoplication, or laparoscopic fundoplication, is a surgical procedure to treat gastrointestinal conditions such as GERD and hiatal hernias.
A fundoplication is a type of laparoscopic surgery. A surgeon will use a long, thin tool called a laparoscope, which has both surgical tools and a camera attached to it.
This allows the surgeon to make small incisions in the body and feed the laparoscope into place, rather than making larger cuts that expose the organs.
Once in place, the laparoscope sends a video feed to a monitor, which the surgeon will look at to perform the surgery.
For a fundoplication, the surgeon will gather the uppermost part of the stomach, called the fundus, and gently wrap and suture it around the lower esophageal sphincter. This helps increase pressure in the esophagus and make acid reflux less likely.
In some cases, fundoplication may also involve other steps to treat related issues, such as hiatal hernias.
A doctor may recommend a fundoplication to help treat the following conditions:
Doctors may recommend fundoplication for people with severe GERD symptoms who cannot find relief using more conservative approaches.
The symptoms of GERD can be painful and reduce a person’s quality of life. They may also cause complications if the person does not receive treatment.
Making dietary changes to avoid trigger foods or making lifestyle changes can help people with mild-to-moderate GERD symptoms.
Some prescription medications may alter acid levels in the stomach to help control GERD symptoms, as well.
Doctors will generally reserve fundoplication for people in whom these other methods do not work to relieve symptoms. In these cases, it may provide a way to reduce acid reflux and make the symptoms more manageable.
Fundoplication is also a standard treatment for hiatal hernias.
Hiatal hernias occur when a piece of the upper part of the stomach pushes out through an opening in the diaphragm, which is the muscle that separates the chest and the abdomen.
Smaller hiatal hernias may not cause any symptoms, and they may not need treatment if they heal on their own.
Some hiatal hernias may cause symptoms similar to those of GERD, including heartburn and acid reflux, making a thorough and accurate diagnosis important in each case.
Sometimes, a doctor may recommend fundoplication to repair and treat hiatal hernias. They generally reserve the procedure for people whose symptoms do not respond to less invasive treatments.
The preparation and procedure will vary slightly depending on the type of surgery a person is having. A doctor will provide instructions and more information on what to expect.
If a person is a good candidate for fundoplication, a doctor will go over the specific instructions to prepare them for the surgery.
For example, they may ask the person to only consume clear liquids and to avoid certain medications for the 2 days leading up to the surgery.
During the surgery
A person having a fundoplication will be asleep under general anesthetics and will not feel any pain.
During the surgery, the surgeon will make a few incisions in the abdomen and move the laparoscope and tools into place.
They will then take the fundus and wrap it around the lower end of the esophagus and esophageal sphincter, securely attaching it.
By wrapping and suturing the fundus to the lower esophageal sphincter, the surgery increases pressure in the lower esophagus.
This makes acid reflux less likely, as it adds enough force to help keep the esophageal sphincter closed.
There are a few different types of fundoplication, and a doctor will discuss each option beforehand. Types of fundoplication surgery vary based on how many degrees the fundus wraps around the esophageal sphincter.
- Nissen fundoplication (360 degree): This is the standard fundoplication procedure. The surgeon will wrap the fundus around the bottom of the esophagus completely.
- Toupet fundoplication (270 degree): In this surgery, the surgeon leaves a bit of room rather than completely encircling the esophagus. This has a similar effect to a standard fundoplication, but it may make it easier to release pressure, such as gas buildup from eructation (burps).
- Watson fundoplication (180 degree): A Watson fundoplication only wraps the fundus around half of the esophagus. This may cause fewer side effects than other fundoplication procedures.
As a laparoscopic surgery, fundoplication generally has a better recovery time than open surgery.
Laparoscopic surgeries are less invasive and only require a few small cuts in the body. These surgical wounds typically take less time to heal than larger cuts.
The process may also reduce the risk of long-term scarring, as well as pain during recovery.
After fundoplication surgery, a person can typically expect to go home from the hospital within 2 days. They will receive special instructions on how to care for their surgical wounds.
This often includes not bathing for the first days after being discharged, regularly changing the dressings on wounds, and washing the wounds with gentle soap.
People will need to follow a special diet after fundoplication, as the stomach needs time to heal.
They may need to receive food through a gastrostomy tube. In these cases, a doctor will go over the process with the patient, and they will arrange for the supplies and food to be sent to their house.
Gastrostomy tube feeding may last for a few weeks, but it can occasionally last longer.
After this, it may be safe to gradually introduce regular foods again. This often includes working with a specialist to introduce soft foods at first, moving to solid foods with time.
Soft foods may include:
- gelatin dessert
During the recovery period, it is important to work with a doctor or dietitian to ensure that the diet contains enough nutrients.
Although fundoplication surgery can help people control acid reflux and ease the symptoms, side effects are common.
For instance, a full 360 degree fundoplication helps with the symptoms of reflux, but it also makes it difficult for the sphincter to open at other times to release pressure.
This can make it very difficult for the person to burp or vomit when necessary.
Because of this, many people experience side effects from fundoplication, such as:
- increased abdominal gas
- pain in the abdomen
- increased flatulence
If a doctor or a patient has concerns about side effects from increased gas, they may choose an alternative procedure, such as the 270 or 180 degree fundoplication.
One 2016 meta-analysis found that both the 270 degree and 360 degree fundoplication procedures have similar success rates when it comes to controlling symptoms.
People who had 270 degree fundoplication had fewer side effects just after the surgery, but the risk of side effects from both surgeries tended to even out with time.
Many people are satisfied with fundoplication surgery, but complications are still possible.
Complications from the surgery itself include:
- accidental piercing of the esophagus, stomach, or other tissues during surgery
- difficulty swallowing
- stitches breaking
- infections in the surgical area or surrounding organs
Also, it is important to note that surgery is not permanently effective in every case. The authors of a 2014 study found that 7% of people who have a 360 degree fundoplication will have to repeat the surgery at least once.
Long-term side effects, such as increased gas in the abdomen, are also possible.
People who already experience gas or pain from bloating should discuss alternative options with their doctor beforehand.
Fundoplication is the standard surgical treatment for GERD in people whose bodies do not respond well to medical treatment or home remedies.
The surgery is minimally invasive and has a shorter recovery time than open surgeries.
Some people may experience both short- and long-term complications, such as increased gas in the abdomen.
Fundoplication surgery is not a replacement for other treatment methods. Doctors will likely still recommend making dietary and lifestyle changes to help control symptoms, and they may also recommend taking medications to support these changes.