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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.
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Fundoplication; Nissen fundoplication; Belsey (Mark IV) fundoplication; Toupet fundoplication; Thal fundoplication; Hiatal hernia repair; Endoluminal fundoplication
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:
Surgery is done while you are under general anesthesia (asleep and pain-free). Surgery usually takes 2 - 3 hours.
Ways your doctor may do this surgery are:
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.
Why the Procedure Is Performed
Your doctor may suggest surgery when:
Risks of any anesthesia are:
Risks of any surgery are:
Risks of this surgery are:
Before the Procedure
Your doctor may ask you to have these tests:
Always tell your doctor or nurse if:
During the week before your surgery:
On the day of your surgery:
Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure
Patients who have laparoscopic surgery usually spend 1 - 3 days in the hospital. Those who have open surgery may spend 2 - 6 days in the hospital after the procedure.
Most patients go back to work 2 - 3 weeks after laparoscopic surgery and 4 - 6 weeks after open surgery.
See also: Anti-reflux surgery - discharge
Anti-reflux surgery is a safe operation. Heartburn and other symptoms should improve after surgery. But some people still need to take drugs for heartburn after surgery.
Some people will need another surgery in the future to treat new reflux symptoms or swallowing problems. This may happen if the stomach was wrapped around the esophagus too tightly, the wrap loosens, or a new hiatal hernia develops.
Brant K, Oelschlager BK, Eubanks TR, Pellegrini CA. Hiatal hernia and gastroesophageal reflux disease. In: Sabiston Textbook of Surgery, 18th ed. Philadelphia, PA: WB Saunders; 2007:chap 42.
Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 140.
Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM. American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383-1391.
Wilson JF. In the clinic: gastroesophageal reflux disease. Ann Intern Med. 2008;149(3):ITC2-1-ITC2-15.
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. Health Solutions, Ebix, Inc.
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