Primary Anti-Reflux Surgery (Fundoplication)

Primary anti-reflux surgery, also known as fundoplication, is a surgical procedure used to treat gastroesophageal reflux disease (GERD) and other conditions that cause stomach acid to flow back up into the esophagus. The goal of the surgery is to strengthen the lower esophageal sphincter (LES) and prevent acid reflux.

Types of Fundoplication

There are several types of fundoplication procedures, including:

• Nissen fundoplication: This is the most common type of fundoplication. It involves wrapping the upper portion of the stomach (fundus) around the lower esophagus to create a new valve.
• Toupet fundoplication: This procedure involves wrapping the fundus around the esophagus, but only partially, leaving a small portion of the stomach unwrapped.
• Dor fundoplication: This procedure involves wrapping the fundus around the esophagus and attaching it to the diaphragm.
• Hill repair: This procedure involves repairing the LES by tightening the muscles around the esophagus.

Indications for Surgery

Primary anti-reflux surgery is typically recommended for patients who:

• Have severe GERD symptoms that do not respond to medical treatment
• Have complications of GERD, such as esophagitis or stricture
• Have a large hiatal hernia
• Are unable to tolerate long-term medical therapy
• Have respiratory symptoms, such as asthma or chronic cough, that are related to GERD

Surgical Techniques

Primary anti-reflux surgery can be performed using:

• Open surgery: This involves making a large incision in the abdomen to access the stomach and esophagus.
• Laparoscopic surgery: This is a minimally invasive procedure that uses small incisions and a camera to visualize the surgical site.
• Robotic-assisted surgery: This is a type of laparoscopic surgery that uses a robotic system to assist with the procedure.

Risks and Complications

As with any surgical procedure, primary anti-reflux surgery carries risks and complications, including:

• Bleeding or hemorrhage
• Infection
• Adhesions or scar tissue
• Dysphagia (difficulty swallowing)
• Gas-bloat syndrome
• Recurrence of GERD symptoms

Postoperative Care and Recovery

After primary anti-reflux surgery, patients typically:

• Stay in the hospital for 1-3 days
• Follow a liquid diet for several weeks
• Avoid heavy lifting or strenuous activities for 4-6 weeks
• Experience some discomfort, bloating, or gas during the recovery period

Long-term Results and Outcomes

Primary anti-reflux surgery is generally effective in reducing GERD symptoms and improving quality of life. Studies have shown that:

• 80-90% of patients experience significant improvement in symptoms
• 50-70% of patients are able to stop taking antacid medications
• 10-20% of patients may experience recurrence of GERD symptoms over time

Overall, primary anti-reflux surgery is a safe and effective treatment option for patients with severe GERD or other conditions that cause stomach acid to flow back up into the esophagus.