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Fundoplication


Expert reviewer Mr Peter Lamb, Consultant General and Upper Gastrointestinal Surgeon
Next review due July 2022

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

If you have GORD, the contents of your stomach come back up into your oesophagus. A muscular valve called a sphincter, usually stops this from happening, but if you have GORD, the valve doesn't work as well. Your stomach contents are acidic, and 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 help treat GORD, your doctor will usually suggest medicines called proton pump inhibitors and making some lifestyle changes (like changes to your diet). For most people, these medicines control the symptoms of GORD. But some people find it difficult to take them long-term. If your doctor thinks you may benefit from fundoplication surgery, they’ll refer you to a surgeon who will assess whether or not this will help.

Hiatus hernia is a condition in which part of your stomach slides up into your chest, through a hole in your diaphragm. It’s a common cause of GORD. If you have a hiatus hernia, your doctor can perform the fundoplication at the same time as repairing your hernia.

Types of fundoplication

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

  • Nissen's fundoplication. Your surgeon will wrap the top part of your stomach all the way around the lower part of your oesophagus.
  • Partial fundoplication. Your surgeon will wrap your stomach 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. It’s also possible that you may need to have your fundoplication by open surgery, where a single, bigger cut is made in your abdomen.

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What are the alternatives to fundoplication?

If your doctor has suggested a fundoplication operation, you’re likely to have already tried lifestyle measures and medicines to deal with your GORD. The main alternative to having the operation is to continue taking medicines (such as proton pump inhibitors) long-term.

Doctors are also investigating a new procedure for GORD, which involves inserting a ring of magnetic beads around your oesophagus. This is a relatively new procedure and there isn’t enough evidence to say how well it works yet. So, it’s unlikely that you’ll be offered this type of procedure just yet, except in special circumstances.

Deciding on fundoplication

If you’re considering having a fundoplication, your surgeon will discuss what’s involved in the procedure, including 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.

Here are some points to consider.

  • For many people, having the procedure controls their symptoms and means they will no longer need to take medicines for reflux.
  • It takes around six weeks to recover from surgery. You’ll have to restrict your diet during this time, and you may have some side-effects such as difficulty swallowing, discomfort after eating and bloating. For more information on this, see our section: Recovering from fundoplication below.
  • Although rare, surgery also carries the risk of more serious complications — such as damage to another organ. You may need further operations if this happens. For more information on this, see our section: Complications of fundoplication below.
  • The symptoms of GORD come back in around one to two in 10 people who have fundoplication. You may need another operation or to continue with medication if this happens.

Preparing for fundoplication

Your surgeon will explain how to prepare for your operation. If you smoke, you’ll be advised to stop because it increases your risk of getting a chest and wound infection, which can slow your recovery.

You may need to stay in hospital overnight or for several days if you’re having open surgery — so be sure to make any necessary preparations. If you go home on the same day, you’ll need someone to drive you home and stay with you overnight.

You’ll have the operation under general anaesthesia, which means you’ll be asleep during the operation. Having a general anaesthetic means 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.

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?

Fundoplication takes between one and two hours. It’s usually carried out by keyhole (laparoscopic) surgery. Once the anaesthetic has taken effect, your surgeon will make five small cuts through the skin of your tummy. This gives them access to the inside of your tummy. They’ll use a laparoscope (a narrow, flexible, telescopic camera) to look inside your body. The camera sends images from inside your body to a monitor, which your surgeon will look at during the operation.

If you have a hiatus hernia, your surgeon will usually repair this first. Next, they’ll wrap the top part of your stomach around the lower end of your oesophagus and sew this into place. Your stomach may be wrapped all the way around your oesophagus (a Nissen’s fundoplication). Or, if it’s a partial fundoplication, it’ll be wrapped just part of the way round. This will leave either the front or back of your oesophagus exposed. At the end of the operation, your surgeon will close the cuts in your skin with stitches — these may be dissolvable.

Although uncommon, it’s possible you may need to have fundoplication surgery via open surgery. Your surgeon will access your stomach and oesophagus by making one vertical cut from the bottom of your breastbone to just above your tummy button. It’s also possible that if there are any problems during or after a keyhole procedure, your surgeon may need to convert to open surgery.

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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 and give you a follow-up appointment date. You’ll also be given some information about what you can eat and drink while you recover.

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 problems 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.

Many people feel sick after their operation. This usually only lasts for a short time. You might find it difficult to swallow for the first few days or weeks, and you might also have some 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 avoid very solid foods, such as meat, bread and pasta for around six weeks. You shouldn’t have fizzy drinks either. For more information, see our FAQ: Can I drink fizzy drinks after fundoplication? Below.

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 can sometimes continue for longer than normal. This might happen if the wrap around your oesophagus is too tight. If you’re still having problems after around 12 weeks, you may need an examination to check whether everything is OK. Sometimes you may need another operation.
  • You might feel bloated and pass wind more frequently. Your doctor may be able to give you medicines to help with this. Rarely, you may need another operation.
  • Your stomach, oesophagus or other organs nearby, such as your spleen, could be damaged during the operation. If you have severe pain or constant vomiting, contact the hospital where you had the operation straight away.
  • You may find that the symptoms of GORD come back after the operation. You might need a second operation or treatment with medicines if this happens.

Frequently asked questions

  • You can, but it’s best to avoid them for the first six weeks, while you recover.

    After fundoplication, you might have difficulty burping because the valve at the top of your stomach is tighter. This can cause gas to build up in your stomach, and you can feel bloated and pass wind more frequently. This can be quite uncomfortable or even painful. Because fizzy drinks increase gas in your stomach, your surgeon is likely to recommend that you don’t have them for at least six weeks.

    Your hospital will give you a diet plan to follow for a few weeks until you’ve recovered. Ask your surgeon if you're not sure what’s best to eat and drink after your operation.

  • It’s possible for children to have a fundoplication, but it’s not very common. It’s only used for children who have serious problems with gastro-oesophageal reflux disease, which can’t be controlled with medicines.

    Gastro-oesophageal reflux is common in babies. It can happen because the muscles controlling the valve that separates your baby’s oesophagus and stomach haven’t developed properly. This means that their feed can come back up from their stomach. Most babies grow out of this by the time they’re a year old. Things might also get better once they start eating solid food as having a mainly liquid diet of milk doesn’t help.

    If your baby is having problems with gastro-oesophageal reflux, your doctor may suggest some changes to their feed or treatment with medicines. Fundoplication is reserved for the most severe cases in children, where these other measures haven’t worked. This operation can strengthen the valve between your child’s oesophagus and stomach. Not all children will benefit from having this procedure. Your doctor will be able to explain more about the risks and benefits involved.

  • For anyone who has a fundoplication, it’s possible for the wrap around your oesophagus to ‘fail’ after surgery. This might mean that it becomes disrupted, comes undone or moves up into your chest. If you get pregnant after having fundoplication, there’s a chance that the changes that can happen to your body when you’re pregnant could cause these kinds of complications. This could be because things like vomiting from morning sickness raises the pressure in your tummy (abdomen) or delivery of your baby disrupts the wrap.

    There’s little research in this area, but a small trial that did look into it found that pregnancy didn’t seem to increase the failure rate of fundoplication. If you’re a woman of child-bearing age, it’s something your surgeon may discuss with you before your operation, just to make sure you’re aware of the potential risks.


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Related information

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    • Laparoscopic Nissen fundoplication. Medscape. emedicine.medscape.com, updated 29 August 2018
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    • Maret-Ouda J, Wahlin K, El-Serag HB, et al. Association between laparoscopic antireflux surgery and recurrence of gastroesophageal reflux. JAMA 2017; 318(10):939–46. doi:10.1001/jama.2017.10981
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    • Gonzalez R, Bowers SP, Swafford V, et al. Pregnancy and delivery after antireflux surgery. Am J Surg 2004; 188:34–38
  • Reviewed by Pippa Coulter, Freelance Health Editor, July 2019
    Expert reviewer Mr Peter Lamb, Consultant General and Upper Gastrointestinal Surgeon
    Next review due July 2022



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