Fundoplication: How It’s Done & What It’s For
Did you know that fundoplication can be used to treat chronic acid reflux and GERD? By wrapping the stomach around the oesophagus, this procedure strengthens the lower esophageal sphincter, offering long-term relief from reflux symptoms.
What is Fundoplication?
Fundoplication is a surgical procedure designed to treat gastroesophageal reflux disease (GERD) and other conditions associated with severe acid reflux, where stomach acid flows back into the oesophagus. This reflux can lead to symptoms such as heartburn, regurgitation, difficulty swallowing, and chest pain.
The procedure involves wrapping the top of the stomach (fundus) around the lower oesophagus to reinforce the lower esophageal sphincter (LES), preventing acid from flowing back up.
Fundoplication can be performed laparoscopically, a minimally invasive method, or through open surgery, depending on the patient’s condition and the surgeon’s recommendation.
When is Fundoplication Recommended?
Fundoplication is typically recommended when GERD or acid reflux is severe, frequent, and does not respond to other treatments such as lifestyle changes, medications, or endoscopic therapies. It may also be used in cases where complications from GERD, such as esophageal stricture, Barrett’s esophagus, or chronic aspiration pneumonia, are present.
Surgical intervention, like fundoplication, is considered when other medical treatments fail to provide relief or if complications arise that warrant more aggressive intervention.
Benefits of Fundoplication Surgery
Fundoplication offers a range of benefits for patients struggling with chronic reflux. Some of the main advantages of this procedure include:
Symptom Relief
Reduced Dependence on Medications
Prevention of Complications
Nissen Fundoplication
Overall, patients who undergo successful fundoplication surgery often experience significant improvements in their symptoms, leading to a healthier, more comfortable life.
Types of Fundoplication
Nissen Fundoplication
Nissen fundoplication is the most common and widely used type of fundoplication. It involves the complete wrapping of the stomach’s top (fundus) around the lower esophagus, with the goal of tightening the LES and preventing acid reflux. The wrap is typically 360 degrees, forming a full seal around the oesophagus.
Nissen fundoplication is particularly effective for treating GERD, especially in cases where the LES is weak and unable to perform its function of preventing acid from backing up into the oesophagus. This technique not only strengthens the LES but also prevents herniation of the stomach through the diaphragm, a condition known as a hiatal hernia.
One key advantage of Nissen fundoplication is its ability to provide lasting relief from symptoms, and it is often the go-to surgery for patients who have chronic, severe GERD or complications that haven’t responded to medication.
Toupet Fundoplication
Toupet fundoplication is another variation of the procedure, but it involves only a partial wrap of the stomach. Unlike the Nissen procedure, which involves a full 360-degree wrap, the Toupet wrap typically involves a 270-degree wrap around the oesophagus.
Toupet fundoplication is often considered for patients who may experience swallowing difficulties or bloating with a complete wrap. This procedure is designed to avoid these complications by leaving part of the oesophagus exposed, allowing some flexibility. The partial wrap still provides sufficient protection from acid reflux while offering fewer restrictions on the movement of the oesophagus and stomach.
Toupet fundoplication may be particularly beneficial for patients with underlying motility disorders of the oesophagus or those who are concerned about the risk of developing post-surgery complications related to food passage.
Fundoplication vs. LINX Procedure
Both fundoplication and the LINX procedure are designed to treat GERD, but they differ slightly in technique and approach.
While fundoplication involves a surgical wrap of the stomach around the esophagus to strengthen the LES, the LINX procedure uses a ring of magnetic titanium beads placed around the lower oesophagus to strengthen the LES and prevent acid reflux.
The main advantages of the LINX procedure over fundoplication are its minimally invasive nature and the fact that it generally has fewer post-operative restrictions on swallowing and eating.
Both procedures have proven effectiveness, and the choice between them often depends on individual patient needs, the extent of GERD, and the surgeon's recommendation.
Risks of Fundoplication Surgery
Like all surgeries, fundoplication carries certain risks, and it’s important for patients to be aware of them before undergoing the procedure. Common risks include:
Difficulty Swallowing
Bloating
Gas and Belching Problems
Infection
Most of these risks are manageable, and complications are relatively uncommon when the procedure is performed by an experienced surgeon.
Recovering from Fundoplication
Immediately following surgery, patients are usually advised to remain in the hospital for a brief period for observation. Most individuals can expect to return to normal activities within 2 to 6 weeks, though full recovery may take longer.
Diet
Pain Management
Follow-up Care
Long-Term Care
While recovery time may vary, patients can generally expect significant relief from their reflux symptoms, with a reduction in the need for medication and fewer instances of GERD-related complications.
Whether undergoing a Nissen, Toupet, or other variation of the procedure, patients should work closely with their acid reflux doctor to determine the best treatment based on their specific condition. With proper care and recovery, the outcomes for those undergoing fundoplication are often very favorable.
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