The most commonly performed surgery for GERD, laparoscopic fundoplication is an outpatient procedure that takes about an hour and a half to complete and requires general anesthesia. During the procedure, the surgeon makes four small incisions in the abdomen and inserts a flexible tube with a tiny camera at the tip to help guide the surgeon throughout the surgery.
The surgeon then takes a portion of the upper stomach, called the fundus, and wraps it around the bottom of the esophagus to form a valve between the stomach and the esophagus. This strengthens the lower esophageal sphincter, which prevents stomach acid from flowing up into the esophagus.
There are two main variations: the Nissen fundoplication, in which a portion of the stomach is wrapped completely around the esophagus, and the Toupet fundoplication, in which a portion of the stomach is wrapped partway around the esophagus. Both procedures are effective. Your surgeon reviews your medical history and diagnostic test results to determine which is appropriate for you.
A surgeon can also repair a hiatal hernia during a laparoscopic fundoplication. To do so, the surgeon gently pushes the top of the stomach back down below the diaphragm, straightens the esophagus, and then closes the hole in the diaphragm with sutures, and sometimes surgical mesh, to ensure that the stomach stays in place.
People treated with laparoscopic fundoplication can usually go home the day of surgery but occasionally after overnight observation. Your doctor may ask you to consume only liquids for a week or two after surgery and then gradually introduce soft foods.
Research has shown that the vast majority of people who undergo laparoscopic fundoplication no longer require medication for the treatment of GERD. People experience symptom relief within as little as a week after surgery. Some experience a mild recurrence of symptoms many years after surgery, usually treated with the occasional use of medication.
The most common side effect of laparoscopic fundoplication is difficulty swallowing after surgery. This lasts for only a few weeks, until your esophagus slowly adjusts. In addition, the repaired esophageal muscle is initially so strong that gas may become trapped in the digestive system, leading to bloating and flatulence. These symptoms usually subside after a few weeks, when the muscles relax after surgery.