Acid Reflux Treatment Phase 3 - Fundoplication Surgery

The drugs usually are effective in treating the GERD. Nevertheless, sometimes they are not. For example, despite adequate suppression of acid and relief from heartburn, regurgitation, with its potential for complications in the lungs, may still occur. Moreover, the amounts and/or numbers of drugs that are required for satisfactory treatment are sometimes so great that drug treatment is unreasonable. In such situations, Fundoplication surgery can effectively stop reflux.

Acid Reflux Treatment Phase 3 - Fundoplication Surgery

With the Fundoplication procedure, the physician wraps the upper part of the stomach (fundus) completely around the esophagus to form a collar-like structure. The collar places pressure on the LES and prevents stomach fluids from backing up in to the esophagus. The procedure relieves GERD-induced coughs and some other respiratory symptoms in up to 85% of patients. It may enhance stomach emptying and improve peristalsis in about half of patients. More than 90% of patients are free of heartburn after the operation and satisfied with their choice, even after 5 years.

Laparoscopic Fundoplication Procedure

  • Tiny incisions are made in the abdomen.
  • Small instruments and a tiny camera are inserted through tubes through which the surgeon can view the region.
  • The surgeon creates a collar using the fundus, although the area is smaller to work with.

Overall, laparoscopic fundoplication appears to be safe and effective in people of all ages, even very small babies. Laparoscopy is more difficult to perform in certain patients, including those who are obese, who have a short esophagus, or who have a history of previous surgery in the upper abdominal area. It may also be less successful in relieving atypical symptoms of GERD including cough, abnormal chest pain, and choking. In about 8% of laparoscopies, it is necessary to convert to open surgery during the procedure because of unforeseen complications.

Good Candidates

Fundoplication is recommended for patients whose condition includes one or more of the following :

  • Esophagitis (Inflamed Esophagus)
  • Symptoms That Persist Or Are Recurrent In Spite Of Anti-reflux Drug
  • Strictures
  • Failure To Gain Or Maintain Weight (Children)

Postoperative Problems & Complications

Postoperative problems can include a delay in intestinal functioning causing bloating, gagging, and vomiting. They usually resolve in a few weeks. A 2003 study suggested, however, that 38% of patients develop such symptoms, and most occur more than year after the procedures. If symptoms persist or if they start weeks or months after surgery, particularly if vomiting is present, then surgical complications are likely. Complications include the following :

1. An Excessively Wrapped Fundus

This is fairly common and can cause difficulty swallowing or experience gagging, gas, bloating, or inability to burp. (A follow-up procedure that dilates the esophagus using an inflated balloon may help correct dysphagia, although not other symptoms.)

2. Bowel Obstruction
3. Wound Infection
4. Injury To Nearby Organs

5. Respiratory Complications

Such as a collapsed lung. These are uncommon, particularly with laparoscopic fundoplication.

6. Muscle Spasms After Swallowing Food

This can cause intense pain and patients may require a liquid diet, sometimes for weeks. This is a rare complication in most patients, but can be very high in children with neurologic abnormalities. Such children are, unfortunately, at very high risk for GERD in the first place.

Reasons For Fundoplication Failure

Long-term failure rates after fundoplication have been reported at 30% after 5 years to 63% after 10 years. Hiatal herniation is the most common reason for surgical failure and the need for a repeat fundoplication. Other common reasons for reoperation include breakdown, slippage, and excessive tightness of the wrap. Surgeon experience can lessen complication risks. Some studies have reported repeat operations after open procedures in between 9% and 30% of cases and 13% after laparoscopy.