Fundoplication Surgery for Gastroesophageal Reflux Disease (GERD)
During fundoplication surgery, the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place so that the lower portion of the esophagus passes through a small tunnel of stomach muscle. This surgery strengthens the valve between the esophagus and stomach ( lower esophageal sphincter ), which stops acid from backing up into the esophagus as easily. This allows the esophagus to heal.
- This procedure can be done through the abdomen or the chest. The chest approach is often used if a person is overweight or has a short esophagus.
- This procedure is often done using a laparoscopic surgical technique. Outcomes of the laparoscopic technique are best when the surgery is done by a surgeon with experience using this procedure.
What To Expect After Surgery
If open surgery (which requires a large incision) is done, you will most likely spend several days in the hospital. A general anesthetic is used, which means you sleep through the operation. After open surgery, you may need 4 to 6 weeks to get back to work or your normal routine.
If the laparoscopic method is used, you will most likely be in the hospital for only 2 to 3 days. A general anesthetic is used. You will have less pain after surgery, because there is no large incision to heal. After laparoscopic surgery, most people can go back to work or their normal routine in about 2 to 3 weeks, depending on their work.
After either surgery, you may need to change the way you eat. You may need to eat only soft foods until the surgery heals. And you should chew food thoroughly and eat more slowly to give the food time to go down the esophagus.
Why It Is Done
Fundoplication surgery is most often used to treat GERD symptoms that are likely to be caused in part by a hiatal hernia and that have not been well controlled by medicines. The surgery may also be used for some people who do not have a hiatal hernia. Surgery also may be an option when:
- Treatment with medicines does not completely relieve your symptoms, and the remaining symptoms are proved to be caused by reflux of stomach juices.
- You do not want or, because of side effects, you are unable to take medicines over an extended period of time to control your GERD symptoms, and you are willing to accept the risks of surgery.
- You have symptoms that do not adequately improve when treated with medicines. Examples of these symptoms are asthma, hoarseness, or cough along with reflux.
How Well It Works
- In most people who have laparoscopic surgery for GERD, the surgery improves symptoms and heals the damage done to the esophagus. footnote 1
- Over time, some people have symptoms come back, have esophagitis come back, need to take medicine for symptoms, or need another operation. footnote 1
- Surgery can cause new and troublesome symptoms. Over time, some people have trouble swallowing, have increased flatulence (gas), and/or have trouble belching. footnote 1
Risks or complications following fundoplication surgery include:
- Difficulty swallowing because the stomach is wrapped too high on the esophagus or is wrapped too tightly.
- The esophagus sliding out of the wrapped portion of the stomach so that the valve ( lower esophageal sphincter ) is no longer supported.
- Heartburn that comes back.
- Bloating and discomfort from gas buildup because the person is not able to burp.
- Excess gas.
- Risks of anesthesia.
- Risks of major surgery (infection or bleeding).
For some people, the side effects of surgery—bloating caused by gas buildup, swallowing problems, pain at the surgical site—are as bothersome as GERD symptoms. The fundoplication procedure cannot be reversed, and in some cases it may not be possible to relieve the symptoms of these complications, even with a second surgery.
What To Think About
GERD can be annoying and even painful. But it is not a dangerous disease. For any GERD treatment to be worth trying, it needs to be very safe. For many people, especially those who have few problems taking medicine, surgery is not a good choice.
But when fundoplication surgery is successful, it may end the need for long-term treatment with medicine. When you are deciding between surgery and treatment with medicine, weigh the cost, risks, and potential complications of the surgery against the cost and inconvenience of taking medicine.
Before surgery, additional tests will usually be done to be sure that surgery is likely to help cure GERD symptoms and to diagnose problems that could be made worse by surgery.
Second surgeries are harder to do, are less successful, and are more risky. So it is extremely important that the first procedure be considered carefully and be done by an experienced surgeon who is more likely to be successful the first time.
Surgery to treat GERD is rarely done on people who:
- Are older adults, especially if they have other health problems in addition to GERD.
- Have weak squeezing motions (peristalsis) in the esophagus. These motions are important to move food down the esophagus to the stomach. Surgery may make this problem worse, causing food to get stuck in the esophagus.
- Have unusual symptoms that might be made worse by surgery.
In special cases, other surgeries such as partial fundoplication or gastropexy may be done instead of fundoplication surgery.
- Lundell L, et al. (2007). Seven-year follow-up of a randomized clinical trial comparing proton-pump inhibition with surgical therapy for reflux oesophagitis. British Journal of Surgery, 94(2): 198–203.
Other Works Consulted
- Galmiche J-P, et al. (2011). Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD. JAMA, 305(19): 1969–1977.
Current as of: November 14, 2014