Fundoplication—Endoscopic 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. The procedure is done through an endoscope, which is a lighted tube with a camera on the end.
    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:
    • Infection
    • Bleeding
    • Difficulty swallowing
    • Return of reflux symptoms
    • Limited ability to burp or vomit
    • Gas pains
    • Damage to organs
    • Anesthesia-related problems
    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
    This procedure does not require incisions. A lighted tube with a camera on the end, called an endoscope, will be inserted through your mouth and down the esophagus. The scope will reach the first part of the stomach. The stomach will then be wrapped around the esophagus. If needed, any hernia will be repaired.
    How Long Will It Take?
    Less than an hour
    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
    2-3 days (may be more or less depending on your condition)
    Post-procedure Care
    At the Hospital
    After surgery, you can expect the following:
    After surgery, you can expect the following:
    • Walk with assistance the day after surgery.
    • 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.
    It will take a few days to one week 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
    • Persistent nausea and/or vomiting
    • 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

    Endoscopoic transoral incisionless fundoplication (TIF) or Esophyx. Medical College of Wisconsin website. Available at: http://www.mcw.edu/generalsurgery/patientinfo/Foregut-Surgery-Program/Reflux-Disease/TIF.htm. Accessed December 9, 2013.

    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.

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