Fundoplication is a surgical procedure that helps prevent the stomach contents from flowing back up the food pipe, called the esophagus. It is a surgical treatment for gastroesophageal reflux disease (GERD) and hiatal hernia.
Fundoplication is not a substitute for other GERD treatments and management techniques, such as making dietary and lifestyle changes. In fact, doctors
Keep reading to learn more about the fundoplication procedure, including the different types, what to expect, and more.
Fundoplication is a surgical procedure that treats gastrointestinal conditions. The surgery
In laparoscopic surgery, a surgeon inserts a long, thin tool called a laparoscope, which acts as both a surgical tool and a camera. The surgeon can make small incisions in the body and feed the laparoscope into place.
Open surgery requires the surgeon to make a large incision in the abdomen. They will then operate directly on the stomach and esophagus.
During fundoplication, the surgeon gathers the upper portion of the stomach, the fundus, and gently wraps and sutures it around the lower esophageal sphincter. This increases pressure in the esophagus and makes acid reflux less likely.
In some cases, fundoplication may also involve other steps to treat related issues, such as a hiatal hernia.
A doctor may recommend fundoplication to help treat the following conditions:
GERD
Doctors may recommend fundoplication for people with severe
The symptoms of GERD can be painful and unpleasant. They may also cause complications, such as injuries to the esophagus, and can increase a person’s risk of esophageal cancer.
People with mild to moderate symptoms can make dietary changes to avoid trigger foods. They can also take prescription medications to alter the acid levels in the stomach.
If these treatment methods do not work, a doctor may consider fundoplication.
Hiatal hernia
Fundoplication is also a standard treatment for hiatal hernias.
Hiatal hernias occur when a piece of an organ —
Smaller hiatal hernias may not cause any symptoms and can heal on their own.
However, some hiatal hernias may cause symptoms similar to those of GERD, such as heartburn and acid reflux. A doctor may recommend fundoplication to repair and treat the hernia. However, they generally reserve the procedure for people whose symptoms do not respond to less invasive treatments.
The preparation and procedure vary depending on whether the person is having a laparoscopic or open procedure. A doctor will provide instructions and more information on what to expect.
Preparation
If a doctor recommends fundoplication, they will explain the necessary preparation for the surgery. For example, they
During the surgery
A person having a fundoplication will be asleep under general anesthesia regardless of whether they are undergoing an open or laparoscopic procedure.
During the surgery, the surgeon will make a few incisions in the abdomen and move the laparoscope and tools into place. If a person has open surgery, surgery begins with a larger incision.
The surgeon will then take the fundus and wrap it around the lower end of the esophagus and esophageal sphincter, securely attaching it. There are
After the surgery
A person will wake up from surgery in the post-anesthesia care unit or recovery room. They may feel confused or groggy.
Most people who have fundoplication will need to stay in the hospital overnight, although some surgeons may discharge a person on the same day as their procedure.
It is also possible that gas pain will affect the shoulders, as the surgeon will use gas in the procedure to expand the abdomen and make the organs more visible.
Most people can return to work and normal life within a week or two, and they can drive as soon as they no longer need opioids or other mind-altering pain medication.
There are a few different types of fundoplication, and a doctor will discuss each option with the individual beforehand. The types of fundoplication surgery vary in terms of how many degrees the fundus wraps around the esophageal sphincter.
They include:
Nissen fundoplication
The 360-degree Nissen wrap style is the
In some people, these complications persist after surgery. Research suggests that as many as 10% of people who have a Nissen procedure still have dysphagia a year later. Between 1% and 10% of people require another operation.
Toupet fundoplication
This 270-degree wrap does not completely wrap around the base of the esophagus. This makes it easier to release pressure, such as the gas that builds up before a person burps. This easier pressure release may prevent pain and complications.
Watson or Dor fundoplication
The Watson and Dor procedures cover even less of the esophagus. A Dor procedure wraps 200 degrees around the esophagus, whereas a Watson procedure covers 180 degrees — the absolute minimum necessary for the procedure to work.
Both may cause fewer complications and a reduction in dysphagia following surgery.
Research suggests that partial wraps may work just as well as the full Nissen wrap, as long as the wrap covers at least half — meaning 180 degrees — of the esophagus. The surgeon’s comfort with various wrap styles and the person’s anatomy will determine the chosen type of wrap.
Laparoscopic fundoplication generally has a
These surgeries are less invasive and only require a few small cuts in the body. The small surgical wounds typically take less time to heal than larger cuts. The process may also reduce the risk of long-term scarring and pain during recovery.
After fundoplication surgery, a person can typically expect to go home from the hospital within 3 days. They will receive special instructions on how to care for their surgical wounds.
These instructions often include not bathing for the first days after being discharged, regularly changing the dressings on wounds, and washing the wounds with gentle soap.
Diet
People will need to follow a special diet after fundoplication.
Very rarely, they may need to receive food through a gastrostomy tube. In these cases, a doctor will explain the process to the individual and arrange the delivery of the supplies and food 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 introduce regular foods gradually, starting with soft foods and moving to solid foods in time.
Soft foods may include:
- applesauce
- yogurt
- soup
- Jell-O
During the recovery period, it is important to work with a doctor or dietitian to ensure that the diet contains enough nutrients and calories.
Although fundoplication surgery can help people control acid reflux and ease the symptoms, side effects are common.
For instance, a
Due to this, many people experience side effects from fundoplication, such as:
- increased abdominal gas
- pain in the abdomen
- bloating
- increased flatulence
If a doctor or individual has concerns about the side effects of increased gas, they may choose an alternative procedure, such as the 270- or 180-degree fundoplication.
Many people feel satisfied with fundoplication surgery. In a 2021 study involving 111 people who had laparoscopic Nissen fundoplication, 78.4% said that they would recommend the surgery, while 15.3% would choose not to have the surgery again.
The outcomes of the surgery are generally positive, and complications are relatively uncommon. However, they are still possible and may include:
- accidental piercing of the esophagus, stomach, or other tissues during surgery
- difficulty swallowing
- stitches breaking
- infections in the surgical area or surrounding organs
- bleeding
- intense pain
Sometimes, the surgery does not work.
A 2019 study looked at the complication rates following outpatient Nissen fundoplication. Of 7,734 patients, 316 (4.1%) had to return to the hospital after surgery. The most common complications that required this readmission were:
- infections: 16.1%
- dysphagia: 12.9%
- abdominal pain: 11.7%
Fundoplication is the standard surgical treatment for GERD in people who do not respond to more conservative treatment methods. Laparoscopic surgery is usually preferable because it is minimally invasive and has a shorter recovery time than open surgery.
However, surgery is not a replacement for other treatment methods. Doctors will likely still recommend dietary and lifestyle changes to control the symptoms.