You can consider the fundoplication to be the grandfather of anti-reflux surgical procedures. For several decades, fundoplication has been a successful, safe, and effective procedure for patients with severe GERD. By wrapping the upper portion of the stomach around the lower portion of the esophagus – the muscle known as the lower esophageal sphincter, we can effectively add pressure to this very important valve, with food continuing to pass into the stomach, but blocking gastric juices from refluxing into the esophagus.
Nissen Fundoplication
The Nissen Fundoplication is a procedure in which the stomach’s fundus (the upper, floppy portion) is wrapped completely around the lower part of the esophagus. It is considered a 360-degree wrap. This wrap recreates the stomach’s natural one-way valve, which helps prevent reflux. Patients must follow a primarily liquid diet for a couple weeks after surgery and slowly advance to solid foods as swelling subsides. Patients are given a dietary manual to follow after surgery.
Toupet Fundoplication
A Toupet Fundoplication is a partial stomach wrap (usually a 270-degree wrap around the esophagus). It is often used for patients with abnormal esophageal function who may be at higher risk for difficulty swallowing (dysphagia) after surgery.
Most patients undergoing a Nissen or Toupet fundoplication will also have a hiatal hernia repair. This is where the hiatus or opening in the diaphragm has expanded, allowing the stomach to push through the larger gap.. This gap is closed by suturing the muscle together during surgery. Learn more about hiatal hernias.
The Considerations of a Fundoplication
While the fundoplication remains an excellent option for qualifying patients, there are specific considerations that candidates should be aware of.
- Fundoplication requires a significant recovery, including a short period of modified food intake—about 4 to 6 weeks.
- The restriction, especially that of a Nissen fundoplication, can be significant enough to cause gas bloat syndrome in some patients, where gas produced within the stomach cannot be released.
- This procedure is inappropriate for gastric sleeve patients experiencing new or worsened GERD.
An Alternative to Fundoplication
The LINX Reflux Management System is a small bracelet-like implanted device that performs the job of a fundoplication while mitigating some of its considerations. The LINX system can be placed over a gastric sleeve. The flexible beaded bracelets expand to accommodate gastrointestinal upset, thus reducing the likelihood of gas bloat syndrome. Finally, patients are encouraged to eat solid foods after this procedure rather than being limited to liquid for a few weeks. Learn more about LINX.
