Fundoplication surgery is an extremely common and successful procedure for treating chronic gastroesophageal disorder (GERD) as well as hiatal hernias. Prior to undergoing this procedure, accurate and precise diagnosis for fundoplication surgery is vital. This will ensure you are a good candidate for the procedure and that it is able to effectively address the underlying problem.

What Is Fundoplication Surgery?

Understanding the diagnosis for fundoplication surgery

Fundoplication is a minimally-invasive surgery that improves the lower esophageal muscle (LES) and prevents stomach acid from being absorbed back into the esophagus. The most popular form, Nissen fundoplication, involves wrapping the top of your stomach (the fundus) around the LES. This procedure is suggested for those suffering with chronic acid reflux that isn’t responding to medications or lifestyle modifications.

Why Accurate Diagnosis Is Crucial Before Fundoplication

Before you perform fundoplication, it is essential to ensure that:

The signs are caused by GERD or hiatal hernia.
The LES is not working properly.
Other conditions that are not similar to reflux symptoms.

An incorrect diagnosis could result in an ineffective treatment, ongoing symptoms or even complications following surgery. Doctors rely on several tests to make an accurate, scientifically-supported diagnosis.

Signs That May Lead to a Diagnosis

Before making a decision to order tests, a physician will evaluate the clinical signs. Signs that indicate the possibility of GERD (also known as hiatal hernia) comprise:

Heartburn that is chronic
Regurgitation of food, or the sour liquid
Trouble swallowing (dysphagia)
Chest pain
Sore throat or chronic cough
A lump of sensation is felt in the throat
Laryngitis or hoarseness

If the symptoms persist, even with medication like proton pump inhibitors (PPIs) and further investigation is recommended.

Key Diagnostic Tests for Fundoplication Surgery

Below are the most important diagnostic tools utilized by gastroenterologists in determining the need for fundoplication surgery:

Upper Endoscopy (EGD – Esophagogastroduodenoscopy)

Objective: To examine visually the stomach, esophagus and the upper small in the intestine.

Why It’s Done:
This test aids doctors in checking for:

Esophageal inflammation (esophagitis)
Ulcers
Barrett’s Esophagus (a precancerous disease)
Restrictions or the narrowing

Procedure A slim, flexible tube that has cameras is passed through the mouth into the esophagus, and then into the stomach.

Esophageal pH Monitoring

The purpose of this test is to measure acidity levels of the stomach during the course of 24 to 48 hours.

Why It’s Done:
It is considered to be the best method to diagnose GERD. It is used to determine the frequency and length of episodes of acid reflux.

Types:

The pH measurement is done via a catheter (through via the nose)
The wireless pH capsule (attached briefly in the stomach)

Esophageal Manometry

The purpose of this test is to determine the pressure and movement of the esophagus as well as LES.

Why It’s Done:
The test will determine if the esophageal muscles function properly, specifically the LES. It is crucial prior to surgery since the weak esophageal motility could require an altered surgical procedure.

Procedure A thin tube is introduced through the nose into the esophagus, to determine the strength of the muscles during swallowing.

Barium Swallow (Upper GI Series)

Objective: To identify structural problems in the stomach and esophagus.

Why It’s Done:
An X-ray of a barium swallow helps determine:

Hiatal hernias
Restrictions or the narrowing
Abnormal esophageal motility
Reflux events

Procedure A patient is able to drink the solution barium, and the X-ray images are captured in real-time.

Bravo pH Monitoring System

Goal: To provide a more relaxing way to perform long-term monitoring of acid levels.

Why It’s Done:
This latest technology allows patients to carry out routine activities while keeping track of acid levels.

Advantages:

Wireless and more comfortable than pH testing with catheters
Offers monitoring for 48 hours

When Is Surgery Recommended After Diagnosis?

After having completed all diagnostic steps A multidisciplinary team will determine whether surgery is needed. It is generally recommended to fundoply in the following situations:

The lifestyle changes and the medications haven’t worked.
The patient suffers from chronic, severe reflux.
In some cases, complications like Barrett’s esophagus may be present.
Hiatal hernias are diagnosed.
The quality of life can be significantly affected by symptoms of reflux.

Risks of Skipping the Diagnosis Phase

Rushing or skipping the process of diagnosis can result in negative consequences.

Ineffective treatment when the symptoms aren’t caused by GERD
The risk of complications following surgery increases
Insistent or progressively worsening symptoms
The need for revision surgery

A proper diagnosis is the basis of an effective treatment plan as well as the success of surgical results.

How to Prepare for the Diagnosis Process

To get the most benefit from the diagnosis phase, patients must:

Keep a diary of symptoms, noting frequency, duration and triggers for reflux.
Provide a complete medical background, including any usage of PPIs or antiacids
Make sure you fast before specific tests (e.g. Endoscopy, entoscopy or monitoring pH)
Discuss any concerns, allergies or other issues with their gastroenterologist.

Conclusion

Before any diagnosis for fundoplication surgery is done, a thorough and precise diagnosis is required to prove that GERD or hiatal hernias are the real cause behind symptoms. With a variety of sophisticated diagnostic tests – such as endoscopy, manometry, pH monitoring and imaging — physicians can make informed choices about procedure and make sure that they have the most favorable results.

If you’re suffering from persistent acid reflux, or GERD symptoms and treatment, don’t let them go unnoticed. A timely and accurate diagnosis can result in effective long-term relief with procedures such as the fundoplication procedure.