This procedure is used to treat symptoms associated with gastroesophageal reflux disease (GERD). GERD is characterized by the reflux of stomach acid back into the esophagus. This type of reflux is generally due to a poorly functioning lower esophageal sphincter, which is the muscle that should control the regurgitation of acid and food once it has been swallowed and passed into the stomach. Therefore, the purpose of a fundoplication is to strengthen the barrier between the esophagus and stomach when the sphincter is not functioning normally.
In this procedure, the part of the stomach closest to the esophagus, called the "fundus," is gathered, wrapped up and sewn around the lower esophageal sphincter. This causes increased pressure at the lower end of the esophagus, which in turn reduces reflux. If the patient's reflux is complicated by hiatal hernia, then this condition is treated as well during the fundoplication. The opening in the diaphragm through which the esophagus passes is also tightened during this procedure to assist in preventing acid reflux. 80-85% of GERD patients have relief from reflux after having this procedure.
There are two types of fundoplication: laparoscopic and "open".
In the laparoscopic procedure, 5 five millimeter incisions are made around the patients abdomen. Through one of these incisions, the surgeon places a laparoscope--a thin, viewing tube, which the surgeon uses as a guide through the other organs and throughout the surgery. The images viewed by the laparoscope are reflected on a TV monitor located inside the operating room. Through the other four incisions, the surgeon will insert other tools which will be used to clamp, grasp, cut and sew the fundus and lower esophagus. This type of procedure is relatively painless and the recovery period is minimal compared to the "open" method. The patient will probably be on a liquid diet for 3-7 days after the surgery and begin to return to normal activities after a week.
Patients who have had past surgeries in this area, or who are prone to bleeding profusely may have an "open" fundoplication instead. During this procedure, one, longer incision is made rather than 5 small incisions and there is no laparoscope to assist the surgeon. The hospital stay is usually a few days and the recovery period at-home is more painful and usually takes a few weeks.
Endoscopy is a simpler alternative to fundoplication that you may want to discuss with your physician.
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