Fundoplication Surgery - Nissen fundoplication – GERD Surgery – Laparoscopic nissen fundoplication – Fundoplication - Gastro-oesophageal reflux
What is Fundoplication Surgery?
Fundoplication is a surgical procedure designed to treat severe gastroesophageal reflux disease (GERD). It works by reinforcing the weak valve between your oesophagus and stomach—the Lower Esophageal Sphincter (LES)—to prevent stomach acid, bile, and other contents from flowing back up. This highly effective procedure is typically recommended when lifestyle changes and medications like PPIs (Proton Pump Inhibitors) fail to control debilitating reflux symptoms.
Key Facts About Fundoplication
- It is the most effective surgical treatment for chronic GERD, with high long-term success rates.
- The procedure is minimally invasive (laparoscopic or robotic) in over 95% of cases, performed through several small incisions.
- It often involves the repair of a hiatal hernia, a common contributing factor to reflux.
- The goal is to create a new valve by wrapping the top of the stomach around the lower esophagus.
Common Types of Fundoplication
The main difference between procedures is the degree of the wrap around the esophagus. Your surgeon will choose the best option based on your symptoms and esophageal function.
Nissen Fundoplication (360° or Full Wrap)
- The most common procedure.
- The gastric fundus is wrapped completely (360 degrees) around the lower esophagus.
- Best for: Classic GERD with heartburn and regurgitation.
- Consideration: Has a higher association with post-op side effects like gas bloat or difficulty swallowing.
Partial Fundoplication (Toupet or Dor)
- The gastric fundus is wrapped partially (270 or 180 degrees) around the esophagus.
- Best for: Patients with weak esophageal motility or who suffer from dysphagia (trouble swallowing) alongside GERD.
Consideration: May have a slightly lower long-term success rate for controlling pure reflux but preserves better ability to belch and vomit.
Common Issues Treated by Fundoplication Surgery
Fundoplication addresses several problems caused by a malfunctioning gastroesophageal junction:
- Chronic Gastroesophageal Reflux Disease (GERD): Persistent heartburn and regurgitation that doesn’t respond to maximum medical therapy.
- Hiatal Hernia: A condition where the top of the stomach pushes through the diaphragm into the chest cavity, weakening the LES.
- Laryngopharyngeal Reflux (LPR): “Silent reflux” where acid reaches the throat, causing hoarseness, chronic cough, and asthma-like symptoms.
- Esophageal Inflammation: Complications from reflux like esophagitis, esophageal ulcers, or Barrett’s esophagus (a pre-cancerous change).
- Regurgitation: The effortless backflow of stomach contents into the mouth, which is often less responsive to medication than heartburn.
When is Fundoplication Surgery Required?
Surgery is a major decision and is typically recommended in these specific scenarios:
- Failed Medical Management: When maximum-dose prescription medications (PPIs) still don’t control symptoms or cause side effects.
- Non-Compliance with Meds: Patients who cannot or do not wish to take lifelong daily medication.
- GERD Complications: To prevent or treat damage caused by acid reflux, such as Barrett’s esophagus, strictures (narrowing), or esophageal ulcers.
- Large Hiatal Hernia: Especially paraesophageal hernias, which carry a risk of twisting or strangulation and often cause significant symptoms.
- Atypical Symptoms: For patients with extra-esophageal symptoms like chronic cough, asthma, hoarseness, or tooth erosion clearly linked to reflux.
- Patient Preference: For individuals who want a permanent, mechanical solution to their reflux disease.
A thorough workup, including an endoscopy and other studies, is essential to determine if you are a good candidate.
Risks and Complications
While generally safe, as with any major surgery, fundoplication carries potential risks:
- Dysphagia: Difficulty swallowing is common immediately after surgery but usually resolves. It can persist long-term in a small percentage of patients.
- Gas Bloat Syndrome: Inability to belch easily, leading to trapped gas and abdominal bloating.
- Recurrent Reflux: The wrap can loosen over time (years), leading to a return of symptoms.
- Wrap Migration/Herniation: The stomach wrap can slip down or push up into the chest, requiring revision surgery.
- General Surgical Risks: Including bleeding, infection, injury to surrounding organs (like the spleen, esophagus, or vagus nerve), or adverse reaction to anaesthesia.
Recovery and Post-Operative Care
Recovery from laparoscopic fundoplication is significantly faster than from open surgery.
- Hospital Stay: Most patients stay 1-2 nights in the hospital.
- Diet Progression: This is crucial for healing and preventing complications.
- Week 1-2: Full liquid diet (broths, smooth soups, protein shakes).
- Weeks 2-4: Pureed/soft foods (mashed potatoes, yogurt, scrambled eggs).
- Weeks 4-6: Gradual introduction of soft solids, chewing thoroughly.
- After 6 weeks: Most can return to a normal diet, avoiding very tough meats and breads initially.
- Activity: No heavy lifting (>10 lbs) or strenuous exercise for 4-6 weeks to allow the internal stitches to heal.
- Pain Management: Most post-op pain is manageable with oral medication and subsides within a week or two.
Long-Term Follow-Up Care
- Symptom Monitoring: Regular check-ins with your surgeon to ensure reflux is controlled and to manage any side effects.
- Dietary Counselling: Working with a dietitian can help you navigate the post-op diet and identify any new food intolerances.
- Medication Review: Many patients can significantly reduce or eliminate their PPI use. This should be done under a doctor’s guidance.
- Lifestyle Maintenance: Maintaining a healthy weight and avoiding known trigger foods remain important for long-term success.
Frequently Asked Questions (FAQs) About Fundoplication Surgery
Will fundoplication cure my GERD completely?
While not a 100% guarantee, fundoplication has a 90-95% long-term success rate in eliminating classic reflux (GERD) symptoms when performed on the right patient by an experienced surgeon.
Can I vomit or belch after the surgery?
This depends on the wrap. With a full (Nissen) wrap, the ability to vomit or belch is often significantly reduced. Partial wraps are designed to better preserve these functions.
Is the surgery reversible?
The procedure is considered permanent. Reversal is complex and risky and is only considered for severe, intractable complications.
How long does the operation take?
A laparoscopic fundoplication typically takes about 90 minutes to perform.
Will I need to change my diet forever?
Not forever, but temporarily. For the first 6 weeks, you will follow a strict staged diet. Long-term, most patients can eat a normal diet but are advised to avoid large, overly large meals and to chew thoroughly.
What is "gas bloat" and will I get it?
Gas bloat is a feeling of fullness and inability to release gas. It is a common side effect, especially with a Nissen wrap, but often improves over several months as the body adjusts.
How long will I be off work?
Most people with sedentary jobs can return to work within 1-2 weeks. Those with physically demanding jobs may need longer.
Will I still need to take acid reflux medication?
Many patients can stop PPIs entirely. Some may need occasional medication or a low dose, especially if they have a partial wrap.
What happens if it fails?
Recurrence can happen years later. If symptoms return, the first step is usually an endoscopy and medication. Revision surgery is an option but is more complex and has lower success rates.
How do I know if I'm a good candidate?
You are likely a good candidate if you: have a confirmed diagnosis of GERD, respond to PPIs (but want to stop them), have a hiatal hernia, and have undergone thorough investigation.