Fundoplication Surgery for Gastroesophageal Reflux Disease (GERD)
During fundoplication surgery, the upper
curve of the stomach (the fundus) is wrapped around the
esophagus and 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), which stops acid from
backing up into the esophagus as easily. This allows the esophagus to
This procedure can be done through the abdomen
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 a
laparoscopic surgical technique. Outcomes of the
laparoscopic technique are best when the surgery is done by a surgeon with
experience using this procedure.
Your doctor may be able to diagnose gastroesophageal reflux disease, or GERD, from your description of symptoms. The doctor may also suggest tests to rule out other possible causes of your symptoms, to monitor the degree of damage, or to determine the best treatment for you.
The three main tests used when GERD is suspected or known are esophageal pH monitoring, endoscopy, and manometry. With pH monitoring, the doctor measures the amount of acid in the esophagus over a 24-48 hour period. This test...
If open surgery (which requires a large
incision) is done, you will most likely spend several days in the hospital. A
general anesthetic is used, which means you sleep through the operation. After
open surgery, you may need 4 to 6 weeks to get back to work or your normal
If the laparoscopic method is used, you will most likely
be in the hospital for only 2 to 3 days. A general anesthetic is used. You will
have less pain after surgery, 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.
surgery, you may need to change the way you eat. You may need to eat only soft
foods until the surgery heals. And you should chew food thoroughly and eat more
slowly to 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 do not 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 are unable to take medicines over an extended period of time to
control your GERD symptoms, and you are willing to accept the risks of
You have symptoms that do not adequately improve when
treated with medicines. Examples of these symptoms are asthma, hoarseness, or
cough along with reflux.
How Well It Works
Laparoscopic surgery improves GERD symptoms in 8 out of 10 people who have the surgery. And surgery heals the damage done to the esophagus by GERD (esophagitis) in about 9 out of 10 people.1
After 7 years, about 4 out of 10 people who had surgery either had symptoms come back, had esophagitis come back, needed to take medicine for symptoms, or needed another operation.1
Surgery can cause new and troublesome symptoms. For example, in the longest study done so far, 7 years after surgery:1
More than 1 out of 10 people had trouble swallowing.
More than 6 out of 10 people had increased flatulence.
More than 2 out of 10 people were unable to belch.
About 3 out of 10 people may still need to take medicine for GERD symptoms after surgery.2
Risks or complications following fundoplication
Difficulty 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.
Bloating and discomfort from gas buildup because the person
is not able to burp.
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 fundoplication procedure cannot be reversed,
and in some cases it may not be possible to relieve the symptoms of these
complications, even with a second surgery.
What To Think About
GERD can be annoying and even painful. But it is not a dangerous disease. For any GERD treatment to be worth trying, it needs to be very safe. For many people, especially those who have few problems taking medicine, surgery is not a good choice.
But when fundoplication surgery is
successful, it may end the need for long-term treatment with medicine.
When you are deciding between surgery and treatment with medicine, weigh the
cost, risks, and potential complications of the surgery against the cost and inconvenience of taking medicine. For more information, see:
Before surgery, additional tests
will usually be done to be sure that surgery is likely to help cure GERD symptoms
and to diagnose problems that could be made worse by surgery.
Second surgeries are harder to do, are less successful, and are
more risky. So it is extremely important that the first procedure be
considered carefully and be done by an experienced surgeon who is more likely
to be successful the first time.
Surgery to treat GERD is rarely
done on people who:
Are older adults, especially if they have other
health problems in addition to GERD.
Have weak squeezing motions
(peristalsis) in the esophagus. These motions are important to move food down
the esophagus to the stomach. Surgery may make this problem worse, causing food
to get stuck in the esophagus.
Have unusual symptoms that might be
made worse by surgery.
In special cases, other surgeries such as partial
fundoplication or gastropexy may be done instead of fundoplication
Lundell L, et al. (2007). Seven-year follow-up of a randomized clinical trial comparing proton-pump inhibition with surgical therapy for reflux oesophagitis. British Journal of Surgery, 94(2): 198-203.
American Gastroenterological Association (2008). American Gastroenterological Association technical review on the management of gastroesophageal reflux disease. Gastroenterology, 135(4): 1392-1413.
Primary Medical Reviewer
Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer
Peter J. Kahrilas, MD - Gastroenterology
August 5, 2010
WebMD Medical Reference from Healthwise
August 05, 2010
This information is not intended to replace the advice of a doctor.
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