Fundoplication—Endoscopic Surgery
Definition
Fundoplication is surgery to wrap the upper stomach around the lower esophagus. It makes backing up of acid into the esophagus from the stomach less likely. The procedure is done through an endoscope, which is a lighted tube with a camera on the end.
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Reasons for Procedure
The surgery is most often done:
- To treat gastroesophageal reflux disease (GERD)
- To reduce acid reflux that is contributing to asthma symptoms
- To repair a hiatal hernia, which may be responsible for making GERD symptoms worse
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
- Upper GI 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.
- 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:
- You will 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 a 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
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
Call Your Doctor
Call your doctor if any of these occur:
- Signs of infection, including fever and chills
- Persistent nausea 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
- New or unexpected symptoms
If you think you are having an emergency, call for emergency medical services right away.
RESOURCES:
National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov
Society of American Gastrointestinal and Endoscopic Surgeons
https://www.sages.org
CANADIAN RESOURCES:
Canadian Association of Gastroenterology
https://www.cag-acg.org
Health Canada
https://www.canada.ca
REFERENCES:
Endoscopic transoral incisionless fundoplication (TIF) or esophyx. Medical College of Wisconsin website. Available at: https://www.mcw.edu/General-Surgery/Patient-Info/GERD-Surgery-Program/Reflux-Disease/TIF.htm. Accessed January 10, 2018.
Gastroesophageal reflux disease. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD. Updated December 4, 2017. Accessed January 10, 2018.
Gastroesophageal reflux disease (heartburn). The Ohio State University Wexner Medical Center website. Available at: https://wexnermedical.osu.edu/digestive-diseases/heartburn. Accessed January 10, 2018.
Hiatal hernia. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116557/Hiatal-hernia. Updated January 2, 2017. Accessed January 10, 2018.
Nissen fundoplication. MUSC Health Digestive Disease Center website. Available at: http://ddc.musc.edu/public/surgery/laparoscopic/fundoplication.html. Accessed January 10, 2018.
Last reviewed November 2018 by EBSCO Medical Review Board Daus Mahnke, MD Last Updated: 12/20/2014