A fundoplication is performed for people with proven gastro-oesophageal reflux that can’t be managed with medication alone. It is also performed as part of a hiatus hernia repair. It is usually performed laparoscopically (keyhole surgery).
The procedure is performed under a General Anaesthetic. Five small incisions are made to act as the keyholes down which the surgeon places instruments to retract the liver and perform the surgery. Often, the first thing that the surgeon does is repair a hiatus hernia if one is present ((see Hiatus Hernia Repair topic))[#].
To perform a fundoplication, the surgeon disconnects the upper part of the stomach (the fundus) from the surrounding tissues to ensure that it is mobile enough to wrap around the junction between the oesophagus (food pipe) and the stomach. Sometimes this involves controlling and ligating through some of the small blood vessels that run from the fundus towards the spleen.
Once the fundus is able to move freely, it is wrapped around the junction of the oesophagus and stomach and stitched in place there with surgical sutures. It can be wrapped around the front (anterior fundoplication) or the back (posterior fundoplication) and can be wrapped around partially or completely. You surgeon can discuss these finer points with you. In essence, a greater degree of wrap will provide a tighter space for food to pass down and gastric acid to pass up and is therefore more effective, but at greater risk of causing swallowing difficulty. Your surgeon will be able to gauge how tight to make your wrap to get the balance as close to perfect as possible.
You will stay in hospital for 1-2 days after your surgery. Sometimes there is a little chest pain in the first couple of days, but most people don’t need much pain relief by the time they go home a few days after surgery.
Your diet will gradually increase from fluids, to puree, soft foods and eventually normal food, over a period of a few weeks. After keyhole surgery your stitches are usually dissolving and there are some small dressings that are removed in the first week or so.
Your surgeon will see you in the office several weeks after your surgery. At this time your diet will be progressed meaning you will be able to eat more normal food and your surgeon will ask you questions about your symptoms. Usually by this time you can swallow as normal and your reflux has completely gone.