Laparoscopic Fundoplication Surgery

Ideal candidates for fundoplication include patients with severe GERD who have failed optimal medical therapy for at least 6 months, those experiencing medication side effects or preferring to avoid lifelong acid suppression, patients with complications from reflux (Barrett's esophagus, strictures, aspiration), and those with documented acid reflux on pH testing. Candidates should have good esophageal motility, realistic expectations about outcomes, and be willing to make permanent dietary modifications. Young patients with severe GERD particularly benefit from surgical treatment to avoid decades of medication dependence.

Long-term results after fundoplication are excellent with high patient satisfaction rates. Studies show 85-90% of patients experience significant symptom improvement that persists for 10+ years. Most patients can eliminate or greatly reduce acid-blocking medications. Quality of life scores improve dramatically, particularly for sleep, diet, and social activities. Some patients may experience gas-bloat syndrome or difficulty belching initially, but these symptoms typically improve over time. Durable symptom control is achieved in most patients, though 5-10% may require revision surgery for recurrent symptoms.

GERD (gastroesophageal reflux disease) occurs when stomach acid frequently flows back into the esophagus, causing heartburn, regurgitation, chest pain, and potential complications. Surgical treatment is considered when medications don't adequately control symptoms after 3-6 months of optimal therapy, complications develop (Barrett's esophagus, strictures, aspiration pneumonia), patients experience intolerable medication side effects, or young patients prefer avoiding lifelong medication. Surgery is also recommended for atypical symptoms like chronic cough or hoarseness when clearly related to acid reflux.

The main types include Nissen fundoplication (360-degree complete wrap around the esophagus), Toupet fundoplication (270-degree posterior partial wrap), and Dor fundoplication (180-degree anterior partial wrap). Nissen provides the most effective reflux control but may cause more gas-bloat symptoms and difficulty belching. Partial wraps (Toupet, Dor) may have fewer side effects but potentially less durable reflux control over time. Your surgeon chooses the best technique based on your esophageal motility, anatomy, previous surgery, and symptom patterns.

Many patients with severe GERD have associated hiatal hernias where part of the stomach slides up through the diaphragm into the chest cavity. This weakens the natural reflux barrier and worsens GERD symptoms. During fundoplication surgery, hiatal hernia repair is often performed simultaneously, involving repositioning the stomach below the diaphragm, removing the hernia sac, and tightening the diaphragmatic opening (crural repair). This combination surgery addresses both the mechanical and functional aspects of GERD for optimal long-term results.

Post-fundoplication dietary changes include eating smaller, more frequent meals (6 small meals vs 3 large), chewing food extremely thoroughly, eating slowly to avoid overfilling the wrap, avoiding carbonated beverages permanently (gas cannot escape easily), limiting gas-producing foods initially (beans, cruciferous vegetables), avoiding drinking large volumes with meals, and maintaining adequate hydration between meals. Most patients can eventually eat a normal variety of foods, though some may permanently avoid certain problem foods. Weight management is important for maintaining surgical results.

Common side effects include temporary difficulty swallowing (dysphagia) for 4-6 weeks as post-operative swelling resolves, gas-bloat syndrome with inability to belch or vomit, increased flatulence, early satiety requiring smaller meals, and occasional diarrhea. Most side effects improve significantly over 3-6 months as the body adapts. Serious complications are rare but may include wrap loosening, slippage, or migration over time. The majority of patients find that symptom relief far outweighs side effects, with 90%+ reporting they would choose surgery again.

Laparoscopic fundoplication has excellent long-term success rates with 10-year studies showing 80-90% of patients maintaining significant symptom improvement. Patient satisfaction rates consistently exceed 85-90%, with most patients able to stop or dramatically reduce acid-suppressing medications. Objective measures like pH testing show normalization of acid exposure in 85-95% of patients. Quality of life improvements are substantial and durable. While some patients may experience gradual symptom recurrence over many years, the majority maintain excellent long-term results without need for revision surgery.

Recovery after laparoscopic fundoplication typically involves 1-2 day hospital stay with same-day discharge increasingly common. Diet progression starts with clear liquids day of surgery, advancing to full liquids, then soft/pureed foods over 2-4 weeks, and finally regular foods by 6-8 weeks. Most patients return to work within 1-2 weeks for desk jobs, 3-4 weeks for physical work. Avoid heavy lifting over 10 pounds for 4-6 weeks. Initial swallowing difficulty is normal and improves over 4-6 weeks. Pain is typically minimal and well-controlled with oral medications.

Revision surgery may be necessary in 5-15% of patients due to wrap loosening, slippage, herniation, or recurrent symptoms over time. Common revision procedures include rewrapping with a different technique, converting from complete to partial wrap, or rarely, takedown of the wrap with alternative procedures. Revision surgery is more complex than initial fundoplication and should be performed by experienced surgeons. Many mechanical problems can be diagnosed with barium swallow or endoscopy. The need for revision has decreased significantly with improved surgical techniques and better patient selection.