fundoplication surgery for gastroesophageal reflux disease (gerd)

surgery overview

during fundoplication surgery, the upper curve of the stomach (the fundus) is wrapped around 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 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.
• this procedure is often done using laparoscopic surgery. this type of surgery works best when it's done by a surgeon who has experience doing it.

if a person has a hiatal hernia, which can cause gastroesophageal reflux disease (gerd) symptoms, it will also be repaired during this surgery.

what to expect

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 normal routine.

if the laparoscopic method is used, you will most likely be in the hospital for only 2 to 3 days. you will have less pain after surgery. that's 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 make sure to chew food thoroughly and eat more slowly. this gives 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 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 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 that don't improve enough when treated with medicines. examples of these symptoms are asthma, hoarseness, and 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 bothersome symptoms. over time, some people have trouble swallowing, more flatulence (gas), and/or trouble belching.^{footnote 1}

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 that comes 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 can't be reversed. and in some cases it may not be possible to relieve the symptoms of these complications, even with a second surgery.