Patient education: Fundoplication (The Basics)

What is fundoplication? — 

This is a surgery to treat gastroesophageal reflux disease, or "GERD." Acid reflux is when the acid that is normally in the stomach backs up into the esophagus (figure 1). In people with GERD, acid reflux causes bothersome symptoms or damage.

In some cases, GERD is caused by a "hiatal hernia." This is when part of the stomach moves up into the chest area (figure 2). In many cases, the doctor can also repair a hiatal hernia during fundoplication.

Fundoplication can be done in 3 ways:

●Open surgery – The doctor makes a cut, or "incision," in the skin. This lets them see directly inside the body when they do the surgery.

●Minimally invasive surgery – This lets the doctor make smaller incisions in the skin. They insert long, thin tools through the incisions. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the body. Then, they use the long tools to do the surgery. They can control the tools directly, or with the help of a robot (called "robot-assisted" surgery).

●Endoscopic surgery – The doctor uses a thin tube with a tiny camera on the end. This is called an "endoscope." It goes into the mouth. The doctor can do the surgery through the endoscope.

You might be able to return to normal activities sooner if you had endoscopic or minimally invasive surgery than if you had open surgery.

How do I prepare for fundoplication? — 

The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Lab tests

●Upper endoscopy – This is a procedure to look at the upper gastrointestinal tract.

●Ph testing of the esophagus

●Esophageal manometry – This measures the pressure in your esophagus when you swallow.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In most cases, you need to "fast" before surgery. This means not eating or drinking anything for a period of time. You might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – You might need to wash your body with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during fundoplication? — 

When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get general anesthesia. This makes you unconscious so you can't feel pain, see, or hear anything during the procedure. You might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will wrap the upper part of your stomach around the lower part of your esophagus (figure 3). This creates a valve that prevents stomach acid and food from leaking back into your esophagus.

●If you have a hiatal hernia, the doctor will also pull your stomach back into your belly and narrow the opening between your chest and belly with stitches. This keeps your stomach from moving back up into your chest.

●The doctor will close your incisions and cover them with clean bandages.

●The procedure usually takes between 1 and 3 hours, depending on whether you have a hiatal hernia.

What happens after fundoplication? — 

You will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Some people stay in the hospital for a short time after surgery. Others can go home later the same day.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of fundoplication? — 

Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Infection

●Bleeding or blood clots

●Trouble swallowing due to the wrap being swollen or too tight

●Limited ability to vomit

●Bloating or gas pains

●Injury to other organs such as the esophagus, spleen, or nearby nerves

●GERD symptoms don't fully go away or come back later

●Hiatal hernia comes back later

What else should I know? — 

Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions, particularly about your diet. Ask questions about anything you do not understand.

More on this topic

Patient education: Fundoplication – Discharge instructions (The Basics)
Patient education: Acid reflux and GERD in adults (The Basics)
Patient education: Acid reflux and GERD during pregnancy (The Basics)
Patient education: Acid reflux and GERD in children and teens (The Basics)
Patient education: Spitting up and GERD in babies (The Basics)
Patient education: Hiatal hernia (The Basics)
Patient education: Upper endoscopy (The Basics)

Patient education: Gastroesophageal reflux disease in adults (Beyond the Basics)
Patient education: Gastroesophageal reflux disease in children and adolescents (Beyond the Basics)
Patient education: Acid reflux (gastroesophageal reflux) in babies (Beyond the Basics)
Patient education: Upper endoscopy (Beyond the Basics)