Fundoplication

About Fundoplication

Fundoplication is an anti reflux operation in which the upper part of the stomach, the fundus, is wrapped around the lower esophagus to strengthen the barrier against reflux of stomach contents. It is used for gastroesophageal reflux disease that is not adequately controlled by medication, for people who prefer surgery to long term medication, and in the repair of hiatal hernias. The Nissen fundoplication, a complete 360 degree wrap, was introduced by the Swiss surgeon Rudolf Nissen in 1956. Partial wraps include the Toupet fundoplication, a posterior wrap of about 270 degrees, and the Dor fundoplication, an anterior wrap often used after surgery for achalasia. Partial wraps tend to cause less difficulty swallowing and are often chosen when esophageal muscle function is weak. The operation is now performed laparoscopically in most cases: the hiatus, the opening in the diaphragm, is narrowed with sutures, and the fundus is passed behind the esophagus and sewn around it over a calibrating tube to avoid making the wrap too tight. Assessment before surgery usually includes upper endoscopy, esophageal manometry to measure muscle function and exclude achalasia, and pH monitoring to confirm reflux. Complications include difficulty swallowing, which is often temporary, gas bloat and inability to belch or vomit, slipping or breakdown of the wrap and recurrent reflux. Magnetic sphincter augmentation, a ring of magnetic beads placed around the lower esophagus, and endoscopic procedures are newer alternatives.