Fundoplication—Laparoscopic Surgery

  • Definition

    Fundoplication is surgery to wrap upper stomach around the lower esophagus. It reduces the amount of acid that enters the esophagus from the stomach. Laparoscopic procedures use small incisions rather than the large incisions that are used during open surgery.
    Fundoplication
    Fundoplication
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  • Reasons for Procedure

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

    Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
    • 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.
    Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as:
  • What to Expect

    Prior to Procedure
    Your doctor may do the following:
    • Physical exam
    • X-ray with contrast—to assess the level of reflux and evidence of damage
    • Endoscopy—use of a tube attached to a viewing device called 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 medications. You may be asked to stop taking some medications up to one week before the procedure, like:
      • Anti-inflammatory drugs
      • Blood thinners
      • Antiplatelets
    • 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
    A small incision will be made. A laparoscope is a small tool with a camera on the end. It 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. Other small incisions will be made in the skin. Small surgical instruments will be inserted. The stomach will then be wrapped around the esophagus. If needed, any hernia will be repaired.
    In some cases, the doctor may need to switch to an open surgery. A wide incision in the abdomen will be made to do the surgery.
    How Long Will It Take?
    2-4 hours
    How Much Will It Hurt?
    Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
    Average Hospital Stay
    Two days or more, depending on your condition
    Post-procedure Care
    At the Hospital
    After surgery, you can expect the following:
    • 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 medications for GERD.
    • Be sure to follow your doctor's instructions.
    It will take about two weeks to recover.
    Preventing Infection
    During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
    • Washing their hands
    • Wearing gloves or masks
    • Keeping your incisions covered
    There are also steps you can take to reduce your chance of infection, such as:
    • Washing your hands often and reminding visitors and healthcare providers to do the same
    • Reminding your healthcare providers to wear gloves or masks
    • Not allowing others to touch your incision
  • Call Your Doctor

    Call your doctor if any of these occur:
    • 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 medications 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 medications 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
    If you think you have an emergency, call for medical help right away.
  • RESOURCES

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

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

    CANADIAN RESOURCES

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

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

    References

    Fundoplication (lap Nissen). MUSC Health Digestive Disease Center website. Available at: http://www.ddc.musc.edu/surgery/surgeries/laparoscopic/fundoplication.cfm. Updated April 30, 2013. Accessed December 9, 2013.

    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 December 9, 2013.

    7/30/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Niebisch S, Fleming F, 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.

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