What is Fundoplication?

Fundoplication is an anti-reflux surgery used for the treatment of gastroesophageal reflux disease (GERD), or acid reflux. Ordinarily, a group of muscles in your throat, called the lower esophageal sphincter, prevents stomach acids, food, and fluids from moving up to the esophagus. GERD occurs when the sphincter weakens and no longer closes tightly enough. The stomach acids can cause inflammation or irritation, which may lead to chest pain, coughing, or a sour taste in your mouth. When medication fails to treat your symptoms, anti-reflux surgery is an option.

Anti-reflux surgery can prevent the flow of stomach acids and other contents into the esophagus by restoring the function of the sphincter. Fundoplication accomplishes this by wrapping the upper portion of the stomach (fundus) partially or fully around the lower esophagus. Food is still able to move down, but the lower esophageal region is tightened, so it is more difficult for stomach contents to return to the esophagus. Nissen fundoplication, in which the upper stomach is wrapped all the way around the lower esophagus, is a common type of anti-reflux surgery.

Nissen fundoplication is most often performed minimally invasively, using a thin tube with a camera, or laparoscope. Laparoscopic fundoplication is done with several small incisions in your abdomen, through which the laparoscope is inserted and the fundus can be accessed. The fundus is then wrapped around the lower esophagus to strengthen the sphincter. Surgery is usually completed within 3-4 hours.

Fundoplication can also be performed with open surgery. However, open fundoplication leads to longer recovery time and is generally associated with higher levels of pain, larger scars, and increased risk of infection than laparoscopic surgery. If laparoscopic Nissen fundoplication cannot be performed safely - which may be the case in the event of scar tissue, infection, or abdominal conditions - your surgeon may opt to perform open fundoplication, which would require a large incision (typically on the abdomen) and can take up to 4 hours.

Following surgery, you may stay in the hospital for up to one week. Your diet will be restricted immediately after your procedure, but you can gradually return to your normal diet within a week. Light activity, such as walking, is encouraged to avoid pneumonia, blood clots, or other complications. Normal activities can usually be resumed within 4-6 weeks.

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