Anti-reflux surgery
Alternative Names: Fundoplication; Nissen fundoplication; Belsey (Mark IV) fundoplication; Toupet fundoplication; Thal fundoplication; Hiatal hernia repair; Endoluminal fundoplication
Anti-reflux surgery is surgery to correct a problem with the muscles at the bottom of the esophagus (the tube from your mouth to the stomach). Problems with these muscles allow gastroesophageal reflux disease (GERD) to happen.
This surgery can also repair a hiatal hernia.
Description of Procedure
GERD is a condition that causes food or stomach acid to come back up from your stomach into your esophagus. This is called gastroesophageal reflux. It can cause heartburn and other uncomfortable symptoms. Reflux occurs if the muscles where the esophagus meets the stomach do not close tightly enough.
A hiatal hernia occurs when the natural opening in your diaphragm from your esophagus is too large. Your diaphragm is the muscle and tissue layer between your chest and belly. Your stomach may bulge through this opening into your chest. This bulging is called a hiatal hernia. It may make GERD symptoms worse.
A procedure called fundoplication is the most common type of anti-reflux surgery. During this procedure, your surgeon will:
- First repair the hiatal hernia with stitches. The surgeon will tighten the opening in your diaphragm to keep your stomach from bulging through.
- Some surgeons place a piece of mesh in the repaired area to make it more secure.
- Your surgeon will then use stitches to wrap the upper part of your stomach around the end of your esophagus. This creates pressure at the end of your esophagus and helps prevent stomach acid and food from flowing back up.
Surgery is done while you are under general anesthesia (asleep and pain-free). Surgery usually takes 2 to 3 hours.
Ways your doctor may do this surgery are:
- Open repair. Your surgeon will make a surgical cut in your belly area (abdomen). Sometimes the surgeon will place a tube from your stomach through the abdomen wall to keep your stomach in place. This tube will be removed when you no longer need it.
- Laparoscopic repair: Your surgeon will make 3 to 5 small cuts in your belly. Your surgeon will insert a laparoscope (a thin, hollow tube with a tiny camera on the end) through one of these cuts and other tools through the other cuts. The laparoscope is connected to a video monitor in the operating room that allows your surgeon to see inside your belly and do the repair. The surgeon may need to switch to an open procedure if there is bleeding, a lot of scar tissue from earlier surgeries, or you are very overweight.
Endoluminal fundoplication is a new procedure that is done to help prevent reflux. It uses a special camera on a flexible tool called an endoscope that is passed down through your mouth and into your esophagus.
Your doctor will place small clips on the inside where the esophagus meets the stomach. These clips help prevent food or stomach acid from backing up.
Risks of Anti-reflux surgery
Risks of any anesthesia are:
- Breathing problems, including pneumonia
- Heart problems
- Reactions to medicines
Risks of any surgery are:
- Bleeding
- Infection
Risks of this surgery are:
- Breathing complications, such as a collapsed lung. This is rare.
- Damage to the stomach, esophagus, liver, or small intestine. This is very rare.
- Gas bloat, which makes it hard to burp or throw up. It also causes bloating after meals. These symptoms slowly get better for most people.
- Pain and difficulty when you swallow. This is called dysphagia. In most people, this goes away during the first 3 months after surgery.
- Return of the hiatal hernia
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Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Ann Rogers, MD, Associate Professor of Surgery; Director, Penn State Surgical Weight Loss Program, Penn State Milton S. Hershey Medical Center. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Copyright 2011 A.D.A.M., Inc.
