Fundoplication Surgery for Gastroesophageal Reflux Disease (GERD)

Surgery Overview

During fundoplication surgery, the upper curve of the stomach (the fundus) is wrapped around the lower end of the esophagus. Then it's 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). The valve stops acid from backing up into the esophagus as easily. This allows the esophagus to heal.

• This procedure is often done using laparoscopic surgery.
• This procedure can be done with an endoscope that is passed through the mouth (transoral incisionless fundoplication, or TIF).
• This procedure can be done through the belly or the chest. The chest approach is often used if a person is overweight or has a short esophagus.

If a person has a hiatal hernia, which can cause gastroesophageal reflux disease (GERD) symptoms, it may also be repaired during this surgery.

What To Expect

If the laparoscopic method is used, you will most likely be in the hospital for 2 to 3 days. After laparoscopic surgery, most people can go back to work or their usual routine in about 2 to 3 weeks, depending on their work.

If you had surgery with an endoscope (transoral incisionless fundoplication, or TIF), your recovery time will be similar to what it is for laparoscopic surgery or slightly less.

If open surgery (which requires a large incision) is done, you will most likely spend several days in the hospital. After open surgery, you may need 4 to 6 weeks to get back to work or your usual routine.

After any of these surgeries, you may need to change the way you eat. You will need to eat only soft foods until the surgery heals. And make sure to chew food thoroughly and eat more slowly. This gives 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 don't 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 to or, because of side effects, you can't take medicines long-term to control your GERD symptoms, and you accept the risks of surgery.
• You have symptoms, such as asthma, hoarseness, and a cough along with reflux, that don't improve enough when treated with medicines.
• You have problems from GERD, such as severe inflammation of the esophagus (esophagitis) or narrowing in the esophagus.

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. Over time, some people's symptoms or esophagitis may come back. Some people may need to take medicine for symptoms or need another operation. And some people have trouble swallowing, more gas, or trouble belching after surgery.

Risks

Risks or complications after fundoplication surgery include:

• Trouble 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 or other GERD symptoms coming back.
• Bloating and discomfort from gas buildup because the person can't 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 surgery may be reversed. But in some cases, it may not be possible to relieve the symptoms of these complications, even with a second surgery.