Gastroesophageal Reflux Surgery Health Article

Risks

Risks or complications that have been associated with fundoplication include:

• heartburn recurrence
• swallowing difficulties caused by an overly tight wrap of the stomach on the esophagus
• failure of the wrap to stay in place so that the LES is no longer supported
• normal risks associated with major surgical procedures and the use of general anesthesia
• increased bloating and discomfort due to a decreased ability to expel excess gas

Complications, though rare, can occur during fundoplication. These complications can include injury to such surrounding tissues and organs, as the liver, esophagus, spleen, and stomach. One of the major drawbacks to fundoplication surgery, whether it is open or laparoscopic, is that the procedure is not reversible. In addition, some of the symptoms associated with complications are not always treatable. One study showed that about 10% to 20% of patients who receive fundoplication have a recurrence of gastroesophageal reflux disease symptoms or develop such other problems, as bloating, intestinal gas, vomiting, or swallowing problems following the surgery. In addition, some patients may develop altered bowel habits following the surgery.

Normal results

One research study found that fundoplication is successful in 50% to 90% of cases. This study found that successful surgery typically relieves the symptoms of gastroesophageal reflux disease and esophagus inflammation (esophagitis). The researchers in this study, however, provided no information on the long-term stability of the procedure. Fundoplication does not always eliminate the need for medication to control gastroesophageal reflux disease symptoms. A different study found that 62% of patients who received fundoplication continued to need medication to control reflux symptoms. However, these patients required less medication than before fundoplication.

Two studies demonstrated that laparoscopic fundoplication improved reflux symptoms in 76% and 98% of the treated populations, respectively. In an additional study, researchers evaluated 74 patients with reflux disease who received Nissen fundoplication after failure of medical therapy. The researchers concluded that 93.8% of the patients had complete resolution of symptoms and did not require anti-reflux medications approximately 14 months after fundoplication. Researchers have found that when fundoplication is successful, the resting pressure in the LES increases. This increase reflects a return to more normal LES functioning where the LES keeps stomach acid in the stomach through increased pressure.

Overall, studies have suggested that the vast majority of patients who receive laparoscopic reflux surgery have positive results. These patients are either symptom-free or have significant improvements in reflux symptoms. The laparoscopic approach has a few advantages over other forms of fundoplication. These advantages include:

• decreased postoperative pain
• more rapid return to work
• decreased hospital stay
• better cosmetic results