What is fundoplication surgery for GERD? How does the laparoscopic antireflux procedure work? Learn about the symptoms, causes, and treatment options for chronic acid reflux.

Understanding Fundoplication (GERD) Surgery

Fundoplication, also known as the Nissen fundoplication procedure, is a common surgical treatment for gastroesophageal reflux disease (GERD). GERD is a chronic condition in which stomach acid flows back (refluxes) into the esophagus, causing symptoms such as heartburn, regurgitation, and difficulty swallowing.

The primary goal of fundoplication surgery is to strengthen the lower esophageal sphincter (LES), the valve-like muscle that connects the esophagus to the stomach. By wrapping a portion of the stomach around the lower esophagus, the procedure helps prevent acid reflux and improve the function of the LES.

Laparoscopic Antireflux Procedure

Fundoplication surgery can be performed using an open or laparoscopic approach. The laparoscopic antireflux procedure is considered a minimally invasive option, as it involves making several small incisions in the abdomen rather than a single large incision.

During the laparoscopic procedure, the surgeon uses a tiny camera (laparoscope) and specialized surgical tools to perform the fundoplication. The surgeon will typically wrap the top part of the stomach (the fundus) around the lower esophagus and secure it in place with stitches, creating a new valve-like structure to prevent acid reflux.

Reasons for Fundoplication Surgery

The most common reason for fundoplication surgery is chronic, severe GERD that does not respond to lifestyle changes or medication. Surgery may be recommended in the following cases:

• Severe or persistent heartburn and acid reflux symptoms
• Damage to the esophagus, such as inflammation or narrowing (stricture)
• Barrett’s esophagus, a precancerous condition caused by chronic acid reflux
• Complications of GERD, such as aspiration pneumonia or respiratory issues

What to Expect During the Procedure

Before the surgery, your doctor may order several tests to evaluate the function of your esophagus and stomach, such as an upper endoscopy, esophageal manometry, or pH monitoring. These tests help the surgeon determine the best approach and ensure that fundoplication is the most appropriate treatment option.

During the laparoscopic fundoplication procedure, the surgeon will make several small incisions in the abdomen and use the laparoscope to guide the surgery. The top part of the stomach is then wrapped around the lower esophagus and secured in place with stitches, creating a new valve-like structure to prevent acid reflux.

Recovery and Potential Complications

Compared to open surgery, the laparoscopic approach typically results in a shorter hospital stay and faster recovery time, with less pain and scarring. Most people can return to their normal activities within 2-4 weeks after the procedure.

While fundoplication is generally considered a safe and effective treatment for GERD, it does carry some potential risks and complications, including difficulty swallowing, gas bloat syndrome, and the need for additional surgery in some cases.

Alternatives to Fundoplication Surgery

If fundoplication is not an appropriate or desired option, there are several other treatments available for GERD, including:

• Medication, such as proton pump inhibitors (PPIs) or H2 blockers
• Lifestyle changes, such as diet modifications, weight loss, and avoiding trigger foods
• Other minimally invasive procedures, such as the LINX procedure or Stretta procedure

It’s important to discuss all treatment options with your healthcare provider to determine the best course of action for your individual needs and circumstances.

Frequently Asked Questions

What is the success rate of fundoplication surgery for GERD?

Fundoplication surgery is generally considered successful in about 85-90% of cases, with the majority of patients reporting significant improvement in their GERD symptoms. However, some patients may still require ongoing medication or experience recurrence of symptoms over time.

How long does the laparoscopic fundoplication procedure take?

The laparoscopic fundoplication procedure typically takes 1-2 hours to complete, depending on the complexity of the case and the surgeon’s experience.

What are the potential side effects of fundoplication surgery?

Some common side effects of fundoplication surgery include difficulty swallowing, gas bloat syndrome (feeling of excessive gas or bloating), and the risk of infection or other surgical complications. However, these side effects are generally manageable and often improve over time.

Is fundoplication surgery covered by insurance?

In most cases, fundoplication surgery for the treatment of GERD is considered a medically necessary procedure and is covered by most major health insurance plans, subject to deductibles, copays, and other plan-specific requirements.