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Fundoplication

Expert reviewer, Mr Peter Lamb, Consultant General and Upper Gastrointestinal Surgeon
Next review due December 2024

Fundoplication is an operation to treat gastro-oesophageal reflux disease (GORD). It involves wrapping the top part of your stomach around your lower oesophagus (the tube that carries food from your mouth to your stomach).

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About GORD and fundoplication

Gastro-oesophageal reflux disease (GORD) is a condition where the contents of your stomach regularly leak back into your oesophagus. Your stomach contents are acidic, so they can irritate the lining of your oesophagus when they come into contact with it. This can cause symptoms such as heartburn – when you get a burning feeling rising up from your stomach towards your neck.

Image showing the digestive system

To treat GORD, your doctor will usually suggest trying indigestion medicines called proton pump inhibitors and making some lifestyle changes. These might include making changes to your diet and losing any excess weight if you need to. For most people, these measures control the symptoms of GORD well. But sometimes, you may find proton pump inhibitors don’t fully control your symptoms, or you can’t take them long-term because of side-effects. In this case, fundoplication surgery could be an option for you.

If your doctor thinks you may benefit from fundoplication surgery, they’ll refer you to a surgeon for an assessment. Fundoplication is an effective procedure for many people and means they no longer need to take medicines for reflux. If you have a hiatus hernia, this will be repaired as part of the fundoplication operation. Hiatus hernia is a condition in which part of your stomach slides up into your chest. It’s a common cause of GORD.

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Types of fundoplication

There are different ways of doing a fundoplication. Here are the most common.

  • Nissen’s fundoplication. This is when your surgeon wraps the top part of your stomach all the way around the lower part of your oesophagus.
  • Partial fundoplication. In this type, your surgeon wraps your stomach just part of the way around your oesophagus. This may be around the front (anterior fundoplication) or the back (posterior or Toupet fundoplication).

Fundoplication is usually done as keyhole (laparoscopic) surgery. This means it’s carried out through very small incisions in your skin. Occasionally, it may be necessary to have your fundoplication by open surgery. This involves your surgeon making a single, bigger cut in your abdomen (tummy).

Preparing for fundoplication

Deciding on surgery

At your first appointment, your surgeon will discuss exactly what’s involved in the procedure so you can decide if it’s right for you. This will include any potential complications and what to expect afterwards. Be sure to ask your surgeon any questions you have and take time to make your decision. If you decide to go ahead, you’ll be asked to sign a consent form, so it’s important to make sure you feel properly informed.

Getting ready for surgery

Your surgeon will explain how to prepare for your operation. If you smoke, your surgeon will advise you to stop. Smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Fundoplication is done under general anaesthesia, which means you’ll be asleep during the operation. You’ll need to stop eating and drinking a few hours before your operation. Your surgeon will give you clear instructions about this. It’s important to follow their advice.

You may need to stay in hospital overnight after your surgery, so be sure to make any necessary preparations. Your stay in hospital is likely to be longer if you have open surgery. Sometimes, you may be able to go home on the day of your procedure. If so, you’ll need someone to drive you home and stay with you overnight.

On the day

On the day of your procedure, your surgeon will meet with you to check you are well and still happy to go ahead. The staff at the hospital will do any final checks and get you ready for surgery. This may include asking you to wear compression stockings or having an injection of an anticlotting medicine to help prevent deep vein thrombosis (DVT).

What happens during fundoplication?

In keyhole surgery, your surgeon inserts small instruments and a tube-like camera through small cuts in the skin of your tummy. If you’re having open surgery, your surgeon will make one long cut from the bottom of your breastbone down to just above your tummy button. Sometimes your surgeon may need to convert from keyhole to open surgery during the procedure.

If you have a hiatus hernia, your surgeon will repair this first. To do the fundoplication, your surgeon wraps the top part of your stomach around the lower end of your oesophagus and sews this into place. They may wrap your stomach all the way around your oesophagus (Nissen’s fundoplication). Or, if you’re having a partial fundoplication, they’ll wrap your stomach just part of the way round.

At the end of the operation, your surgeon will close the cuts in your skin with stitches. These may be dissolvable.

What to expect afterwards

You’ll need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off. Once you’re ready, your nurses will encourage you to get up and move around. This will help to prevent complications. You’ll be able to start having drinks a few hours after your operation, but you won’t be able to eat anything until the following day.

Sometimes you can go home on the day of your operation, but you may need to stay overnight in hospital. If you’ve had open surgery, you’ll usually need to stay in hospital for longer – for between two and five days. Your nurse will give you some advice about caring for your healing wounds before you go home. They’ll give you some information about what you can eat and drink while you recover, too. They’ll also give you a follow-up appointment date.

If your surgeon used clips or non-dissolvable stitches, you’ll need to have these removed after about seven to 10 days. Dissolvable stitches don’t need to be removed – ask your surgeon how long it will take for them to dissolve.

Recovering from fundoplication

It can take up to six weeks for any initial discomfort and side-effects after your fundoplication to settle down. However, the time it takes to fully recover can vary from person to person. Recovery tends to be quicker after keyhole surgery than open surgery.

Side-effects after the operation can include the following.

  • Feeling sick, which usually only lasts for a short time.
  • Having difficulty swallowing for the first few days or weeks.
  • Bloating and discomfort after eating.

 

Follow any advice you’ve been given about what to eat while you recover. This usually involves starting with liquids and gradually moving onto soft foods. You’ll need to take your time when eating, and avoid very solid foods such as meat, bread and pasta for around six weeks. You shouldn’t have fizzy drinks because this can increase gas in your stomach making any bloating worse.

Don’t lift anything heavy for the first month or so after your operation. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen.

Complications of fundoplication

Complications are when problems occur during or after the operation. The possible complications of any operation include things like infection, bleeding or an unexpected reaction to the anaesthetic. Specific complications of fundoplication include the following.

  • Difficulties with swallowing that continue for longer than normal. If you’re still having problems after around 12 weeks, you may need an examination to check whether or not everything is OK. Sometimes you may need another operation.
  • Bloating and increased wind is common but can be more severe in some people. Your doctor may be able to give you medicines to help with this. Rarely, you may need another operation.
  • Rarely, your stomach, oesophagus or other nearby organs, such as your spleen, could be damaged during the operation. If you have severe pain or are being sick constantly, contact the hospital where you had the operation straight away.
  • You may find that the symptoms of GORD come back after your operation. If this happens, you might need a second operation or treatment with medicines.

What are the alternatives to fundoplication?

Your doctor will only offer you a fundoplication operation if you’ve already tried lifestyle measures and medicines first. The main alternative to having the operation is to continue taking medicines (such as proton pump inhibitors) long-term.

Some surgeons are now performing a new procedure for GORD, which involves inserting a ring of magnetic beads around your oesophagus. This allows you to swallow food, but keeps your oesophagus closed afterwards so no acid can leak back up from your stomach. It’s only available in certain centres at the moment.

Frequently asked questions



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Related information

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    • Personal communication, Mr Peter Lamb, Consultant General and Upper Gastrointestinal Surgeon, 30 November 2021

     

  • Reviewed by Pippa Coulter, Freelance Health Editor, December 2021
    Expert reviewer Mr Peter Lamb, Consultant General and Upper Gastrointestinal Surgeon
    Next review due December 2024

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