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Fundoplication -- Open Surgery

Definition

Fundoplication is surgery to wrap upper stomach around the lower esophagus. It reduces the amount of acid that enters the esophagus from the stomach.

Fundoplication
Fundoplication
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

The surgery is most often done for the following reasons:

  • Eliminate gastroesophageal reflux disease (GERD) symptoms that are not relieved by medication
  • Reduce acid reflux that is contributing to asthma symptoms
  • Repair a hiatal hernia, which may be responsible for making GERD symptoms worse
  • Reduce of serious, long-term complications resulting from too much acid in the esophagus

Possible Complications

If you are planning to have fundoplication, your doctor will review a list of possible complications, which may include:

  • 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.

Some factors that may increase the risk of complications include:

  • Pre-existing heart or lung condition
  • Obesity
  • Smoking
  • Diabetes
  • Prior upper abdominal surgery

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
  • 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, like:
    • Anti-inflammatory drugs such as ibuprofen and naproxen
    • Blood thinners
    • Anti-platelet medications
  • 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

Open Procedure/Nissen Fundoplication

A wide incision will be made in the abdomen. This is to expose the stomach and lower esophagus. The upper portion of the stomach will be wrapped around the esophagus. This will create pressure on the lower part of the esophagus. It will reduce the chance of stomach acid from moving up the esophagus. If a hiatal hernia exists, the stomach will be placed entirely back in the abdomen. The opening in the diaphragm where the hernia poked through will be tightened.

How Long Will It Take?

2-4 hours

How Much Will It Hurt?

You will have discomfort during recovery. Ask your doctor about medication to help with the pain.

Average Hospital Stay

2-4 days

Post-procedure Care

After the procedure, you can expect to:

  • Walk with assistance the day after surgery.
  • Keep the incision area clean and dry.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • 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 medicines for GERD.
  • Be sure to follow your doctor's instructions.

It will take about six weeks to recover.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Nausea and/or vomiting that you cannot control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
  • 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
  • Any other new symptoms

In case of an emergency, call for medical help right away.

Revision Information

  • National Digestive Diseases Clearinghouse

    http://digestive.niddk.nih.gov

  • The Society of American Gastrointestinal and Endoscopic Surgeons

    http://www.sages.org

  • The Canadian Association of Gastroenterology

    http://www.cag-acg.org

  • Health Canada

    http://www.hc-sc.gc.ca

  • Fundoplication (lap Nissen). MUSC Health Digestive Disease Center website. Available at: http://www.ddc.musc.edu/surgery/surgeries/laparoscopic/fundoplication.cfm. Updated April 30, 2013. Accessed December 9, 2013.

  • Treating GERD. Ohio State University Medical Center website. Available at: http://medicalcenter.osu.edu/patientcare/healthcare%5Fservices/digestive%5Fdisorders/gerd%5Fheartburn/diagnosing%5Ftreating%5Fgerd/treating%5Fgerd/Pages/index.aspx. Accessed December 9, 2013.

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