Anti-Reflux Surgery (Fundoplication)

1 What is an Anti-Reflux Surgery (Fundoplication)?

Fundoplication (anti-reflux surgery) is a surgical procedure for treating gastro-esophageal reflux disease (GERD) that strengthens the barrier to acid reflux when the sphincter does not function normally.

Usually, there is a barrier to reflux of acid, the lower-most muscle of the esophagus (called the lower esophageal sphincter) which is contracted (constricted or tight) and then closes off the esophagus from the stomach. In patients with GERD, the sphincter does not function normally because the muscle is either weak or relaxes inappropriately.

GERD results when acid refluxes (regurgitates, or backwashes) from the stomach back up into the esophagus and causes inflammation, pain (heartburn), and other serious complications (such as scarring and stricture) of the esophagus.

The procedure can be done with laparotomy, thoracotomy, or laparoscopy. The advantage of the laparoscopic method is a speedier recovery and less post-operative pain.

During the procedure, the part of the stomach that is closest to the entry of the esophagus is gathered, wrapped, and sutured (this is called placation) around the lower end of the esophagus and the lower esophageal sphincter. This procedure increases the pressure at the lower end of the esophagus and thereby reduces acid reflux.

Also, during the procedure, other surgical steps are frequently taken that also may reduce acid reflux. If a patient has a hiatal hernia, the hernial sac may be pulled down from the chest and sutured so that it remains within the abdomen. Additionally, the opening in the diaphragm through which the esophagus passes from the chest into the abdomen also may be tightened. The advantage of the laparoscopic method is a speedier recovery and less post-operative pain.

Alternatives to fundoplication for treating GERD are endoscopic methods. A long flexible tube is swallowed by the patient and on the inside of the esophagus, the surgeon can view through the endoscope and various instruments can be passed through channels in the endoscope. In one of the methods, an instrument is inserted that delivers an electrical current to the lower esophageal sphincter. This results in scarring, which tightens the sphincter and sutures are placed in the sphincter to tighten the sphincter.

After the procedure performed laparoscopically or thoracoscopically, the patient must stay in the hospital at least 5-7 days. The recovery period is 4 to 6 weeks to get back to work or their normal routine. When the procedure is performed laparoscopically, some patients may be discharged home on the same day, plus a recovery period of 2 to 6 weeks.

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