Fundoplication

Fundoplication is a surgical procedure used to treat gastroesophageal reflux disease (GERD) and hiatal hernia. The goal of the surgery is to wrap the upper portion of the stomach, known as the fundus, around the lower part of the esophagus to prevent stomach acid from flowing back up into the esophagus.

Types of Fundoplication

There are several types of fundoplication procedures, including:

• Nissen fundoplication: This is the most common type of fundoplication. The surgeon wraps the entire fundus around the esophagus to create a 360-degree ring.
• Toupet fundoplication: In this procedure, the surgeon wraps only a portion of the fundus around the esophagus, creating a 270-degree ring.
• Dor fundoplication: This type of fundoplication involves wrapping the fundus around the esophagus and attaching it to the diaphragm.

Indications for Fundoplication

Fundoplication is typically recommended for patients who:

• Have severe GERD symptoms that do not respond to medical treatment
• Have a large hiatal hernia
• Experience respiratory problems due to GERD, such as asthma or pneumonia
• Have esophageal strictures or narrowing of the esophagus due to chronic acid reflux

Surgical Approach

Fundoplication can be performed using:

• Open surgery: A single incision is made in the abdomen to access the stomach and esophagus.
• Laparoscopic surgery: Several small incisions are made in the abdomen, and a laparoscope (a thin tube with a camera) is used to visualize the area.
• Robotic-assisted surgery: A robotic system is used to assist the surgeon during the procedure.

Risks and Complications

As with any surgical procedure, fundoplication carries risks and potential complications, including:

• Bleeding or hemorrhage
• Infection
• Adhesions or scar tissue formation
• Dysphagia (difficulty swallowing)
• Gas-bloat syndrome

Recovery and Follow-up

After fundoplication surgery, patients typically:

• Stay in the hospital for 1-3 days
• Follow a liquid diet for several weeks
• Gradually return to solid foods
• Attend follow-up appointments with their surgeon to monitor progress and address any concerns

Outcomes and Success Rates

The success rate of fundoplication surgery varies depending on the individual patient and the severity of their condition. Studies have shown that:

• 80-90% of patients experience significant improvement in GERD symptoms
• 50-70% of patients achieve complete resolution of symptoms