Fundoplication – Surgery for Acid Reflux & GERD
Fundoplication is a surgical procedure used to treat chronic heartburn and acid reflux disease. The upper part of the stomach is wrapped around the lower esophagus to prevent stomach acid from flowing back up.
Things worth knowing about "Fundoplication"
Fundoplication is a surgical procedure used to treat chronic heartburn and acid reflux disease. The upper part of the stomach is wrapped around the lower esophagus to prevent stomach acid from flowing back up.
What Is Fundoplication?
Fundoplication is a surgical procedure in which the upper portion of the stomach (known as the gastric fundus) is wrapped around the lower end of the esophagus and stitched into place. The goal is to strengthen the gastroesophageal junction – the area where the esophagus meets the stomach – so that stomach acid can no longer flow back into the esophagus. This backflow, known as gastroesophageal reflux, causes symptoms such as heartburn, acid regurgitation, and chest discomfort.
When Is Fundoplication Recommended?
Fundoplication is typically considered when conservative treatments such as medications (proton pump inhibitors) and dietary changes do not provide adequate relief, or when long-term medication use is not desired. Common indications include:
- Gastroesophageal reflux disease (GERD): Chronic acid reflux with persistent symptoms
- Hiatal hernia: A condition in which part of the stomach pushes through the diaphragm into the chest cavity
- Barrett esophagus: Changes in the lining of the esophagus caused by long-term acid exposure
- Intolerance or unwillingness to take long-term reflux medications
How Is the Surgery Performed?
Today, fundoplication is almost always performed laparoscopically (minimally invasive, using small incisions and a camera). The procedure is carried out under general anesthesia and typically takes 1 to 2 hours. Several surgical techniques exist:
Nissen Fundoplication (360-Degree Wrap)
In the Nissen fundoplication, the gastric fundus is completely wrapped (360 degrees) around the esophagus. This is the most commonly performed technique and offers a very reliable barrier against acid reflux.
Toupet Fundoplication (270-Degree Wrap)
In the Toupet fundoplication, the fundus is only partially wrapped (270 degrees) around the esophagus. This approach is often preferred when esophageal motility is reduced, as it tends to cause fewer swallowing difficulties.
Dor Fundoplication (180-Degree Wrap)
The Dor fundoplication is an anterior partial wrap most commonly used after surgical treatment of achalasia (a swallowing disorder affecting the esophagus).
Recovery and Aftercare
Following surgery, patients typically stay in the hospital for 2 to 4 days. Dietary adjustments are necessary during the first weeks after the procedure:
- Initially, only liquid and soft foods should be consumed
- Eating slowly and in smaller portions is recommended
- Carbonated beverages and gas-producing foods should be avoided
Full recovery usually takes 4 to 6 weeks. Strenuous physical activity should be avoided during this time.
Risks and Possible Side Effects
As with any surgical procedure, fundoplication carries certain risks. The most commonly reported issues after surgery include:
- Dysphagia: Difficulty swallowing, usually temporary in the first weeks after surgery
- Gas bloat syndrome: Difficulty belching and increased bloating
- Dumping syndrome: Discomfort caused by faster gastric emptying
- Rarely: recurrence of reflux, injury to surrounding structures, or infection
Success Rates and Outcomes
Fundoplication is a well-established and thoroughly studied procedure. Approximately 85 to 90 percent of patients experience long-term relief or significant improvement after surgery. Long-term studies suggest that a proportion of patients may require medication again after several years.
References
- Fuchs, K.H. et al. - Gastroesophageal Reflux Disease. In: Surgical Gastroenterology. Springer Medical Publishing, 2020.
- Koop, H. et al. - S2k Guideline on Gastroesophageal Reflux Disease. AWMF Register No. 021/013, German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS), 2023.
- Lundell, L. et al. - Comparison of outcomes twelve years after antireflux surgery or omeprazole maintenance therapy for reflux esophagitis. Clinical Gastroenterology and Hepatology, 2009.
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