Fundoplications
What is a fundoplication?
The fundoplication is a surgical treatment that is aimed to prevent acid reflux by reinforcing a weak lower esophageal sphincter using tissue from the patient’s own stomach. This surgery is performed on patients who have been diagnosed with gastroesophageal reflux disease (GERD). During the procedure, the upper portion of the stomach is completely wrapped (plicated) around the bottom of the lower esophagus, and then it is stitched into place to create a strong barrier that prevents stomach acid from backing up into the esophagus. This keeps the acid in the stomach from entering the esophagus. Fundoplications can be complete or partial. A complete or 360 degree fundoplication is referred to as a Nissen fundoplication. Various partial fundoplications ranging from 90 degrees to 270 degrees are utilized depending on a patients workup and needs. Fundoplications are performed robotically or laparoscopically requiring 5 small incisions. The decision on what type of antireflux surgery is recommended is dependent on each patients workup, anatomy and severity of disease.
The Nissen fundoplication is one of the anti-reflux surgeries that has been studied the most, and there are over 60 years of data on the procedure’s side effects and durability.
After the surgery, around 90% of patients who suffer from heartburn will be able to stop taking their regular heartburn medication.
After surgery, patients see immediate improvement in their regurgitation and heartburn symptoms.
During a robotic or laparoscopic fundoplication, all size hiatal hernias are repaired.
Although the Nissen fundoplication offers a number of benefits to patients who have moderate to severe GERD, the treatment, like any other medical procedure, is not without its drawbacks. Some of these drawbacks include the following:
Bloating that often occurs after surgery can last for months.
Some individuals may continue to experience dysphagia (difficulty swallowing) for up to six to eight weeks following the operation.
Reduces the volume of solids released when vomiting, which may make some patients believe they have lost the capacity to throw up.
Has a measurable failure rate due to aging and wear and tear that may require revision in the future.
One of the greatest advantages of Nissen fundoplication is that patients can immediately cease using their daily heartburn medications following the treatment. Patients usually return home hours after the procedure. Patients are placed on a liquid diet for two weeks after surgery, a semi-solid diet for weeks 3 and 4 and are on an unrestricted diet by eight weeks. It is recommended that patients take 7-14 days off from work, but there is a weight lifting restriction of no more than 20 pounds for 6 weeks after surgery. Patients are usually able to control any post-operative discomfort with Tylenol and anti-inflammatory medications, but a prescription for a small amount of narcotics is provided as well.