• Fundoplication—Laparoscopic Surgery

    Definition

    Fundoplication is a surgery on the stomach and esophagus. It is done to treat gastroesophageal reflux disease (GERD). GERD is also called acid reflux, or heartburn. This occurs when acid from the stomach goes up the esophagus. A hiatal hernia may also be fixed during this procedure. This type of hernia occurs when a portion of the stomach pokes into the chest cavity. This hernia increases the chance and severity of GERD.
    Fundoplication
    Fundoplication
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    The surgery is most often done for the following reasons:
    • Eliminate persistent GERD symptoms that are not relieved by medicine
    • Correct acid reflux that is contributing to asthma symptoms
    • Repair a hiatal hernia, which may be responsible for making GERD symptoms worse
    • Eliminate the source of serious, long-term complications resulting from too much acid in the esophagus

    Possible Complications

    If you are planning to have fundoplication, your doctor will review a list of possible complications, which may include:
    • Anesthesia-related problems
    • Infection
    • Bleeding
    • Difficulty swallowing
    • Return of reflux symptoms
    • Limited ability to burp or vomit
    • Gas pains
    • Damage to other organs
    In rare cases, the procedure may need to be repeated. This may happen if the wrap was too tight, the wrap slips, or if a new hernia forms.
    Some factors that may increase the risk of complications include:
    • Pre-existing heart or lung conditions
    • Obesity
    • Smoking
    • Diabetes
    • Prior upper abdominal surgery
    • Age: 70 years of age or older

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • Physical exam
    • X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones
    • Endoscopy —use of a tube attached to a viewing device (an endoscope) to examine the inside of the lining of the esophagus and stomach; a biopsy may also be taken
    • Manometry—a test to measure the muscular contractions inside the esophagus and its response to swallowing
    Leading up to the surgery:
      Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Anti-inflammatory drugs (eg, aspirin )
      • Blood thinners, like warfarin (Coumadin)
      • Clopidogrel (Plavix)
    • Arrange for a ride to and from the hospital. Also, arrange for help at home.
    • The night before, eat a light meal. Do not eat or drink anything after midnight.

    Anesthesia

    General anesthesia will be used. It will block any pain and keep you asleep through the surgery.

    Description of the Procedure

    Laparoscopic Procedure
    The doctor will make a small incision. The laparoscope (a small tool with a camera on the end) will be inserted into the abdomen. It will allow the doctor to view the inside of the body on a video screen. Gas will be pumped into the abdomen to improve the view. The doctor will make other, small incisions in the skin. Small surgical instruments will be inserted. The stomach will then be wrapped around the esophagus. If needed, the hernia will be repaired.
    In some cases, the doctor may need to switch to an open surgery . He will make a wide incision in the abdomen to do the surgery.

    How Long Will It Take?

    2-4 hours

    How Much Will It Hurt?

    You will have discomfort during recovery. Ask your doctor about medicine to help with the pain.

    Average Hospital Stay

    Two days or more (depending on your condition)

    Post-procedure Care

    • Walk with assistance the day after surgery.
    • Keep the incision area clean and dry.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • You will start by eating a liquid diet. You will slowly be able to eat more solid foods.
    • After a successful fundoplication, you may no longer need to take medicines for GERD.
    • Be sure to follow your doctor's instructions .
    It will take about two weeks to recover.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
    • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
    • Increased swelling or pain in the abdomen
    • Difficulty swallowing that does not improve
    • Pain that you cannot control with the medicines you have been given
    • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
    • Cough, shortness of breath, or chest pain
    • Any other new symptoms
    In case of an emergency, call for medical help right away.

    RESOURCES

    National Digestive Diseases Clearinghouse http://digestive.niddk.nih.gov/

    The Society of American Gastrointestinal and Endoscopic Surgeons http://www.sages.org/

    CANADIAN RESOURCES

    The Canadian Association of Gastroenterology http://www.cag-acg.org/

    Health Canada http://www.hc-sc.gc.ca/

    References

    EsophyX receives FDA clearance for performing trans oral incisionless fundoplication surgery. Medical News Today website. Available at: http://www.medicalnewstoday.com/articles/83410.php . Published September 24, 2007. Accessed August 19, 2009.

    Society of American Gastrointestinal Endoscopic Surgeons website. Available at: http://www.sages.org/ .

    The Society of Thoracic Surgeons website. Available at: http://www.sts.org/sections/aboutthesociety/practiceguidelines/antibioticguideline/ .

    Transoral incisionless fundoplication with EsophyX. Endogastric Solutions website. Available at: http://www.endogastricsolutions.com/esophyx%5Ffor-pt.htm . Accessed August 19, 2009.

    Treating GERD. Ohio State University Medical Center website. Available at: http://medicalcenter.osu.edu/patientcare/healthcare%5Fservices/digestive%5Fdisorders/gerd%5Fheartburn/diagnosing%5Ftreating%5Fgerd/treating%5Fgerd/Pages/index.aspx . Accessed August 19, 2009.

    7/30/2012 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Niebisch S, Fleming F, Galey K, et al. Perioperative risk of laparoscopic fundoplication: safer than previously reported—analysis of the American College of Surgeons National Surgical Quality Improvement Program 2005 to 2009. American College of Surgeons. 2012(215);61-68.

    Revision Information

    • Reviewer:
    • Review Date: 09/2012
    • Update Date: 00/92/2012
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