Fundoplication is a surgical procedure used to treat gastroesophageal reflux disease (GERD) by reinforcing the lower oesophageal sphincter (LES), the valve between the oesophagus and stomach, to prevent stomach and intestinal liquids (acid, bile etc) from flowing back into the oesophagus. 

This procedure is often recommended for patients who do not respond to lifestyle changes or medication therapy for GERD. 

Fundoplication surgery aims to alleviate symptoms such as heartburn and regurgitation.


Types of Fundoplication Surgery
There are many variations of fundoplication surgery with a bespoke option chosen based on the symptom constellation of individual patients. 

Surgery is usually performed laparoscopically/ robotically and involves repairing any associated hiatus hernia, tightening the hiatus with stitches and wrapping the top of the stomach around the oesophagus to reinforce the gastro-oesophageal junction. The degree of wrap (total, partial etc) is the main difference between individual fundoplication options.

Risks and Complications
While fundoplication surgery is generally considered safe, it may be associated with certain risks and complications, including:

  1. Bleeding
  2. Infection
  3. Injury to surrounding organs (e.g. pneumothorax- air around the lung)
  4. Inability to complete the operation laparoscopically
  5. Digestive side effects such as dysphagia, bloating
  6. Recurrent reflux over the long term
  7. Wrap Migration: In rare cases, the wrap created during fundoplication surgery may migrate or loosen over time, leading to recurrent GERD symptoms.

Recovery and Post-operative Care
After fundoplication surgery, patients will typically spend a few days in the hospital for monitoring and recovery. Recovery times vary depending on the type and extent of the surgery, as well as individual factors such as overall health and fitness. During the recovery period, patients may receive the following post-operative care:

  1. Pain Management: Pain medications may be prescribed to manage discomfort or pain after surgery.
  2. Dietary Changes: Patients will need to follow a modified diet after fundoplication surgery, starting with clear liquids and gradually advancing to soft foods and then solid foods as tolerated. Dietary changes may include eating smaller, more frequent meals and avoiding certain foods that may trigger reflux.
  3. Activity Restrictions: Patients may be advised to avoid strenuous activities, heavy lifting, or driving for a certain period following the procedure.
  4. Monitoring: Patients will be closely monitored for signs of complications such as infection, bleeding, or difficulty swallowing.

Follow-up Care
Follow-up care is essential for patients who have undergone fundoplication surgery and may include:

  1. Regular Medical Check-ups: Patients will need to attend regular follow-up appointments with their healthcare team to monitor recovery, assess symptom improvement, and address any concerns or complications.
  2. Dietary Counseling: Patients may benefit from dietary counseling or support from dietitians to help them adjust to dietary changes and prevent symptoms such as dysphagia or dumping syndrome.
  3. Medication Management: Patients may need to continue taking medications to manage GERD symptoms, although the dosage or frequency may be adjusted based on symptom improvement after surgery.
  4. Lifestyle Modifications: Lifestyle modifications such as maintaining a healthy weight, avoiding trigger foods, and elevating the head of the bed can help optimize the effectiveness of fundoplication surgery and reduce the risk of recurrent GERD symptoms.
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