When lifestyle changes and medications do not offer the patient significant relief from gastroesophageal reflux disease or GERD, surgical intervention can be considered as a long-term curative option. The standard of care for surgical treatment of acid reflux is a fundoplication. Two of the most commonly performed fundoplication are the Nissen or complete fundoplication and the Toupet or partial fundoplication. Depending on the patient’s circumstance, one or both procedures may be appropriate.
How does a fundoplication work?
Before we delve into the procedure details, it is important to review why a fundoplication is needed. Most cases of GERD are caused by the weakened muscles of the lower esophageal sphincter or LES. This is the valve between the esophagus and stomach that allows food and liquid into the stomach but stops stomach acids from refluxing back into the esophagus. When the muscles of the LES do not close properly, reflux is typically the consequence.
During a fundoplication, the fundus or top of the stomach is wrapped around the lower part of the esophagus. The stomach is then sutured in place for long-term effectiveness. The additional compression reinforces the LES and restores much of its normal function. If a hiatal hernia is present, it will be repaired simultaneously. The Nissen fundoplication is also the primary treatment for a paraesophageal hernia
Both the Nissen and Toupet fundoplication are performed in a minimally invasive manner requiring only 3 to 5 small incisions in the abdomen. This greatly reduces the recovery time and return to work. The hospital stay is usually one night and patients can return to activity within 1 to 2 weeks.
Risks of a fundoplication
A fundoplication is typically very successful in improving or eliminating the symptoms of chronic acid reflux. However, as with any other minimally invasive surgical procedure, there are risks inherent to surgery which will be discussed at consultation. These risks are real but occur infrequently (<1%). Some, but not all risks, are listed below:
- Pneumothorax (“dropped lung”)
- Perforation of the esophagus
Even though the fundoplication will make patients feel much better, we still encourage them to lose weight and improve their diet to ensure long-term effectiveness. Poor lifestyle habits can negate the benefits of surgery