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Fundoplication  
Fundoplication

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Definition  

Fundoplication is surgery to wrap the upper stomach around the lower esophagus. It reduces the amount of acid that enters the esophagus from the stomach.

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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 the risk of serious, long-term complications resulting from too much acid in the esophagus
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Possible Complications  

If you are planning to have fundoplication, your doctor will review a list of possible complications, which may include:

  • 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.

Some factors that may increase the risk of complications include:

  • Pre-existing heart or lung condition
  • Obesity
  • Smoking
  • Diabetes
  • Prior upper abdominal surgery
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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 1 week before the procedure.
  • 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  

Open Procedure/Nissen Fundoplication  

A wide incision will be made in the abdomen. This is to expose the stomach and lower esophagus. The upper portion of the stomach will be wrapped around the esophagus. This will create pressure on the lower part of the esophagus. It will reduce the chance of stomach acid from moving up the esophagus. If a hiatal hernia exists, the stomach will be placed entirely back in the abdomen. The opening in the diaphragm where the hernia poked through will be tightened.

How Long Will It Take?  

2-4 hours

How Much Will It Hurt?  

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

Average Hospital Stay  

2-4 days