Fundoplication surgery has been proven to be a safe and successful surgical procedure to treat gastroesophageal resuscitation (GERD) as well as other esophageal diseases. Understanding what is fundoplication surgery can help patients consider their options. If changes in lifestyle, diet management, and medications do not offer lasting relief for acid reflux then fundoplication surgery might be the next option to improve the quality of life.

The procedure of fundoplication is minimally-invasive surgery that is open or that is used to combat chronic acid reflux, often referred to as GERD (Gastroesophageal Reflux Disorder). It is important to know what is fundoplication surgery before undergoing the procedure. In GERD stomach acid often is absorbed by the esophagus, causing irritation to the lining of the stomach and causing symptoms such as regurgitation, heartburn, and difficulties swallowing.

When undergoing fundoplication surgery the upper part of stomach (called the fundus) is wrapped around the lower portion of the esophagus, and then stitched into the proper position. This procedure effectively addresses the question of what is fundoplication surgery. This helps strengthen the lower esophageal muscle (LES) and stops acid from leaking back into the esophagus.

Why is Fundoplication Surgery Performed?

This is generally suggested for:

Chronic GERD is not responsive to medication
Hiatal hernia (when the stomach pushes back into the chest cavity)
Esophagitis (inflammation of the esophagus resulting from exposure to acid)
Barrett’s Esophagus (a precancerous disease)
Regurgitation severe, chest pain or aspiration pneumonia
difficulty swallowing or breathing due to acid reflux related issues

Fundoplication can be a long-term treatment to reflux-related issues and may decrease or eliminate the need for medication that is used regularly, like PPIs (proton pump inhibitors).

Types of Fundoplication Surgery

There are a variety of fundoplication options that are tailored to the individual anatomy and patient requirements:

1. Nissen Fundoplication (360deg wrap)

The most well-known kind
The fundus is completely wrapped around the esophagus.
Offers strong reflux control
Ideal for patients who do not have difficulties swallowing

2. Toupet Fundoplication (270deg partial posterior wrap)

Partially wrapped wraps to minimize chances of difficulty swallowing
It is ideal for patients with poor esophageal mobility

3. Dor Fundoplication (180-200deg anterior wrap)

Anterior wrap is less tight
Most often, they are used in conjunction with other surgeries for the esophageal.
Lower chance of developing postoperative gas-bloat syndrome

The decision will depend on your personal anatomy, the severity of GERD and the surgeon’s knowledge.

The Fundoplication Procedure: Step-by-Step

Fundoplication is generally performed under general anesthesia. It can be done using:

Laparoscopic (Minimally Pervasive) Surgery: Requires small incisions of 4-5 and the using Laparoscope (camera). More rapid recovery and less complications.
Open Surgery: Very rarely required for complicated or repeated surgeries.

Procedure Steps:

Anesthesia is administered and the incisions are made.
The surgeon can visualize the stomach and esophagus.
The stomach’s fundus is re-engaged and is wrapped over the LES.
The wrap is then sutured into the desired position.
A hiatal hernia, when there is one, can be fixed.
The incisions are sealed.

The entire procedure usually takes between one and two hours. The majority of patients return home within two to three days.

Recovery After Fundoplication Surgery

Immediate Post-Surgery Care:

Patients might experience sore throats and abdominal pain, as well as shoulder discomfort (from the gas that is used during laparoscopy).
Walking should be done within 24 hours in order to avoid blood clots.

Diet After Fundoplication:

Week 1: Clear liquids (broth, juice, gelatin)
Week 2: Soft diet (mashed potatoes, applesauce, scrambled eggs)
The 3rd week of the program: gradual return of solid food items

Avoid:

Carbonated drinks
Acidic or spicy foods
Caffeine, alcohol

Full Recovery Time:

2 to 4 weeks for normal activities
6-8 weeks for total healing
The majority of patients feel immediate relief from symptoms of reflux.

Benefits of Fundoplication Surgery

Long-term relief from acidity and heartburn.
Stops chronic cough and regurgitation.
Reduces the chance of damage to the esophagus
Enhances sleep and the life quality
A minimally invasive treatment can result in a faster recovery
Sometimes, it can eliminate the need for acid-suppressing daily medication

Risks and Potential Complications

While fundoplication is generally considered harmless, as is any other procedure there are some dangers:

Trouble swallowing (dysphagia) typically temporary
Syndrome of gas-bloat (inability to burp or gas bloating)
Diarrhea, flatulence or irritable bowel syndrome
Infections or bleeding
Recurrent reflux (rare)
Injuries to organs around (during surgery)

A surgeon who is experienced reduces the risk significantly.

Who is a Good Candidate for Fundoplication Surgery?

You could be eligible If:

You are suffering from persistent GERD symptoms that cannot be controlled with medications
You suffer from a hiatal hernia
Tests such as endoscopy and pH monitoring can confirm acid reflux.
You’d like to eliminate or decrease your long-term dependence on medications for reflux.
Lung issues can be due to aspirated acid

A surgeon and gastroenterologist will assess your health condition using tests like esophageal manometry or upper endoscopy. They will also conduct 24 hour pH monitoring prior to suggesting surgery.

Alternatives to Fundoplication Surgery

Lifestyle shifts (dietary change and weight reduction elevation of the head while sleeping)
Medication (PPIs and antacids H2 blockers)
LINX device implant – A ring of magnetic beads positioned within the LES to reduce reflux
Endoscopic surgeries (e.g., TIF – Transoral Incisionless Fundoplication)

Fundoplication is usually recommended in cases where other treatments don’t work or aren’t suitable.

Conclusion

Fundoplication surgery can be a trusted and long-lasting option for patients who suffer with chronic GERD and other complications associated with acid reflux. Through strengthening the lower esophageal and sphincter of the stomach it stops the reflux of stomach acid and enhances the quality of life.

If you or someone else in your family has frequent heartburn, regurgitation or GERD symptoms, despite medications treatment, fundoplication could be the best next step. Talk to a gastroenterologist or digestive surgeon to determine if this option is appropriate for you.