Fundoplication—Open Surgery Overview

Fundoplication is a surgery on the stomach and esophagus. It is done to treat gastroesophageal reflux disease (GERD). GERD is also called acid reflux or heartburn. This occurs when acid from the stomach goes up the esophagus. A hiatal hernia may also be fixed during the procedure. This type of hernia occurs when a portion of the stomach pokes into the chest cavity. This hernia increases the chance and severity of GERD.

Fundoplication 2009 Nucleus Medical Media, Inc.

Prior to Procedure

Your doctor may do the following:

• Physical exam
• X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones
• Endoscopy —use of a tube attached to a viewing device (an endoscope) to examine the inside of the lining of the esophagus and stomach; a biopsy may also be taken
• Manometry—a test to measure the muscular contractions inside the esophagus and its response to swallowing

Leading up to the surgery:

• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

• Anti-inflammatory drugs (eg, aspirin )
• Blood thinners, like warfarin (Coumadin)
• Clopidogrel (Plavix)
• Arrange for a ride to and from the hospital. Also, arrange for help at home.
• The night before, eat a light meal. Do not eat or drink anything after midnight.

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the surgery.

Description of the Procedure

Open Procedure/Nissen Fundoplication

A wide incision will be made in the abdomen. This is to expose the stomach and lower esophagus. The doctor will wrap the upper portion of the stomach around the esophagus. This will create pressure on the lower part of the esophagus. It will prevent stomach acid from moving up the esophagus. If a hiatal hernia exists, the stomach will be placed entirely back in the abdomen. The doctor will then tighten the opening in the diaphragm where the hernia poked through.

How Long Will It Take?

2-4 hours

How Much Will It Hurt?

You will have discomfort during recovery. Ask your doctor about medicine to help with the pain.

Average Hospital Stay

2-4 days

Post-procedure Care

• Walk with assistance the day after surgery.

• Keep the incision area clean and dry.

• You will start by eating a liquid diet. You will slowly be able to eat more solid foods.

• After a successful fundoplication, you may no longer need to take medicines for GERD.

• Be sure to follow your doctor's instructions .

It will take about six weeks to recover.

RESOURCES:

National Digestive Diseases Clearinghouse
http://digestive.niddk.nih.gov/

The Society of American Gastrointestinal and Endoscopic Surgeons
http://www.sages.org/

CANADIAN RESOURCES:

The Canadian Association of Gastroenterology
http://www.cag-acg.org/

Health Canada
http://www.hc-sc.gc.ca/

References:

EsophyX receives FDA clearance for performing transoral incisionless fundoplication surgery. Medical News Today website. Available at: http://www.medicalnewstoday.com/articles/83410.php . Published September 24, 2007. Accessed August 19, 2009.

Society of American Gastrointestinal Endoscopic Surgeons website. Available at: http://www.sages.org/ .

The Society of Thoracic Surgeons website. Available at: http://www.sts.org/sections/aboutthesociety/practiceguidelines/antibioticguideline/ .

Transoral incisionless fundoplication with EsophyX. Endogastric Solutions website. Available at: http://www.endogastricsolutions.com/esophyx_for-pt.htm . Accessed August 19, 2009.

Treating GERD. Ohio State University Medical Center website. Available at: http://medicalcenter.osu.edu/patientcare/healthcareservices/digestivedisorders/gerdheartburn/diagnosingtreatinggerd/treatinggerd/Pages/index.aspx . Accessed August 19, 2009.