Laparoscopic Fundoplication

Laparoscopic Fundoplication
The upper portion of the stomach (the fundus) is mobilised then wrapped (plicated) around the lower portion of the oesophagus and anchored securely below the diaphragm.

This restores normal pressure to the LOS and prevents acid from refluxing into the oesophagus. The operation is effective long term in stopping gastro-oesophageal reflux and relieving symptoms.

How does laparoscopic fundoplication work?

  • The physical barrier that allows passage of material in or out of the stomach is strengthened.
  • A flap valve is created at the entrance of the stomach.
  • The wrap "inflates" as the stomach fills; and as a result, a full stomach has a tighter valve than an empty one.
  • All the factors that normally create valve pressure (oesophageal muscle, the diaphragm and abdominal pressure) are superimposed on each other for maximum effect.

What are the results like?
Laparoscopic fundoplication is safe and effective in the skilled hands. More than 90 percent of patients who have fundoplication surgery are able to leave hospital the next day, eating a soft diet. Most people are able to return to their normal activities, work or school within one to two weeks after surgery. The satisfaction rate with this procedure is more 95 percent at the final review at one year.

Are there any side effects to laparoscopic fundoplication?
Studies have shown that the vast majority of patients who undergo the procedure are either symptom-free or have significant improvement in their GORD symptoms.
A common but usually short-term problem is called gas-bloat. Since the LOS muscle has been tightened, the patient may be unable to belch, resulting in a feeling of bloating and discomfort. Eating frequent small meals slowly and chewing thoroughly helps.
Long-term side effects to this procedure are generally uncommon.

Other side effects

  • Some patients develop temporary difficulty swallowing immediately after the operation. This usually resolves within one to three months after surgery.
  • Occasionally, patients may require a procedure to stretch the oesophagus (endoscopic dilation) or rarely re-operation.
  • The ability to belch and or vomit may be limited following this procedure. Some patients report stomach bloating.
  • Rarely, some patients report no improvement in their symptoms.

How long will I have to stay in hospital? When can I resume normal activities?
The laparoscopic surgery often requires a hospital stay of only 23 hours. You should be able to return to normal activities between one and two weeks, compared with four to six weeks for traditional surgery.

Who are good candidates for the procedure?
Surgical candidates are those whose heartburn is not well controlled with medicine, those who want to fix the problem without having to take medicine long term, and those who are having complications from reflux, including ulcers, strictures, hernias or Barrett's oesophagus.

What can I expect before and after the surgery?
Patients are counselled before the operation about lifestyle and dietary adjustments that are needed for about six weeks following surgery. They are advised to eat smaller amounts of food at each meal, to chew their food well, and avoid chewing gum and drinking carbonated beverages, to make sure the surgery will heal properly.

What are the success rates for this surgery/procedure?
The success rate for the minimally invasive surgery is 90 to 95 percent for patients who have the typical symptoms of GORD, such as heartburn, regurgitation, or belching. For those with less typical symptoms, including hoarseness and chronic cough, the surgery is about 70 to 80 percent effective at relieving their symptoms.

What to expect before laparoscopic anti-reflux surgery?

  • After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
  • Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
  • Your surgeon may request that you completely empty your colon and cleanse your intestines prior to surgery. You may be requested to drink clear liquids, only, for one or several days prior to surgery.
  • It is recommended that you shower the night before or morning of the operation.
  • After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
  • Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
  • Diet medication should not be used for the two weeks prior to surgery.
  • Quit smoking and arrange for any help you may need at home.

What to expect the day of surgery?

  • You usually arrive at the hospital the morning of the operation.
  • A qualified medical staff member will place a small needle/catheter in your vein to dispense medication during surgery.
  • Pre-operative medications are often necessary.
  • You will be under general anaesthesia - asleep - during the operation which may last several hours.
  • Following the operation you will be sent to the recovery room until you are fully awake.
  • Most patients stay in the hospital the night of surgery and may require additional days in the hospital.

What should I expect after surgery?

  • Patients are encouraged to engage in light activity while at home after surgery.
  • Post operative pain is generally mild although some patients may require prescription pain medication.
  • Anti-reflux medication is usually not required after surgery.
  • Some surgeons modify patient's diet after surgery beginning with liquids followed by gradual advance to solid foods. You should ask your surgeon about dietary restrictions immediately after the operation.
  • You will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, lifting, working and engaging in sexual intercourse.
  • Call and schedule a follow-up appointment within 2 weeks after your operation.

Ashraf Rasheed, MB BCh BAO, FRCS Gen Surg
Mr Rasheed is a Specialist in the Diagnosis and Treatment of Gastro-Oesophageal Reflux