Fundoplication—Open Surgery
Definition
Fundoplication is surgery to wrap the upper stomach around the lower esophagus. It makes backing up of acid into the esophagus from the stomach less likely.
Reasons for Procedure
The surgery is most often done to:
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Infection
- Bleeding
- Difficulty swallowing
- Return of reflux symptoms
- Limited ability to burp or vomit
- Gas pains
- Damage to organs
- Anesthesia-related problems
In rare cases, the procedure may need to be repeated. This may happen if the wrap was too tight, the wrap slips, or if a new hernia forms.
Some factors that may increase the risk of complications include:
- Pre-existing heart or lung condition
-
Obesity
-
Smoking
- Diabetes
- Prior upper abdominal surgery
What to Expect
Prior to Procedure
Your doctor may do the following:
- Physical exam
-
X-ray
with contrast—to assess the level of reflux and evidence of damage
-
Upper GI endoscopy
—use of a tube attached to a viewing device called an endoscope to examine the inside of the lining of the esophagus and stomach
(a
biopsy
may also be taken)
- Manometry—a test to measure the muscular contractions inside the esophagus and its response to swallowing
Leading up to the surgery:
- Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
- Arrange for a ride to and from the hospital. Also, arrange for help at home.
- The night before, eat a light meal. Do not eat or drink anything after midnight.
Anesthesia
General anesthesia
will be used. It will block any pain and keep you asleep through the surgery.
Description of the Procedure
A wide incision will be made in the abdomen. This is to expose the stomach and lower esophagus. The upper portion of the stomach will be wrapped around the esophagus. This will create pressure on the lower part of the esophagus. It will reduce the chance of stomach acid moving up the esophagus. If a hiatal hernia exists, the stomach will be placed entirely back in the abdomen. The opening in the diaphragm where the hernia poked through will be tightened.
How Long Will It Take?
2-4 hours
How Much Will It Hurt?
You will have discomfort during recovery. Ask your doctor about medication to help with the pain.
Average Hospital Stay
2-4 days
Post-procedure Care
After the procedure, you can expect the following:
- You will walk with assistance the day after surgery.
- You will start by eating a liquid diet. You will slowly be able to eat more solid foods.
- After a successful fundoplication, you may no longer need to take medications for GERD.
It will take about 6 weeks to recover.
Call Your Doctor
Call your doctor if any of these occur:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- Persistent nausea or vomiting
- Increased swelling or pain in the abdomen
- Difficulty swallowing that does not improve
- Pain that you cannot control with the medications you were given
- Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
- Cough, shortness of breath, or chest pain
- New or unexpected symptoms
If you think you are having an emergency, call for emergency medical services right away.
Resources
National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov
Society of American Gastrointestinal and Endoscopic Surgeons
https://www.sages.org
Canadian Resources
Canadian Association of Gastroenterology
https://www.cag-acg.org
Health Canada
https://www.canada.ca
References
Gastroesophageal reflux disease. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD
.
Updated December 4, 2017. Accessed January 10, 2018.
Gastroesophageal reflux disease (heartburn). The Ohio State University Wexner Medical Center website. Available at:
https://wexnermedical.osu.edu/digestive-diseases/heartburn.
Accessed January 10, 2018.
Hiatal hernia. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T116557/Hiatal-hernia
.
Updated January 2, 2017. Accessed January 10, 2018.
Nissen fundoplication. MUSC Health Digestive Disease Center website. Available at: http://ddc.musc.edu/public/surgery/laparoscopic/fundoplication.html. Accessed January 10, 2018.