Fundoplication for GERD and Other Conditions: What to Expect

Fundoplication is a last-resort surgery for GERD or a hiatal hernia, which happens when your stomach pushes up through your diaphragm. Your doctor may not recommend this surgery if you haven’t already tried other treatments, home remedies, or lifestyle changes to control your GERD symptoms, such as:

• losing weight, especially if you’re overweight or obese
• eating a GERD-friendly diet or avoiding foods that can trigger reflux, such as alcohol or caffeine
• taking medications for conditions that contribute to GERD, such as insulin for diabetes, or medications that help strengthen your esophagus or stomach muscles

Your doctor may also not recommend this surgery if it won’t help resolve your symptoms. For example, if you have mild gastroparesis, a condition in which your stomach empties slowly, fundoplication will probably help. But fundoplication won’t help treat severe gastroparesis, so other treatments may be necessary.

Several types of fundoplication are possible:

• Nissen 360-degree wrap. The fundus is wrapped all the way around the bottom of your esophagus to tighten the sphincter. This prevents you from any burping or vomiting that may make your GERD worse.
• Toupet 270-degree posterior wrap. The fundus is wrapped about two-thirds of the way around the back side, or posterior, of the bottom of your esophagus. This creates a sort of valve that lets you more easily release gas through burps or vomit when necessary.
• Watson anterior 180-degree wrap. The part of the esophagus next to the diaphragm is reconstructed. Then, the fundus is wrapped halfway around the front, or anterior, of the bottom of the esophagus and attached to part of the diaphragm tissue.

Each procedure can be done laparoscopically. This means that your surgeon makes several small incisions and inserts tiny surgical instruments and a small, thin tube with a camera and light to perform the surgery.

This makes your recovery time faster and leaves smaller scars than an open procedure.

To prepare for this surgery, you may be asked to do the following:

• Consume only clear liquids for at least 24 to 48 hours before the surgery. No solid foods or colored sodas and juices will be allowed during this period.
• Take any prescribed medications to help clear out your digestive tract during the final 24 hours before surgery.
• Don’t take any anti-inflammatory medications, such as ibuprofen (Advil) or acetaminophen (Tylenol).
• Ask your doctor if you should stop taking blood thinners. This includes warfarin (Coumadin). These can increase your risk of complications during surgery.
• Tell your doctor about medications and dietary or herbal supplements you’re taking. You may be asked to stop taking them so they don’t interfere with the surgery.
• Have a family member or close friend take you to the hospital. Have someone available to take you home when you’re released, too.

When you get to the hospital for the surgery, you’ll check in and be led into a room where you can change into a hospital gown.

Then, your doctor will put intravenous (IV) tubes into your veins for both fluid regulation and anesthesia during the surgery. You’ll be asleep during the entire procedure.

Each type of fundoplication has slightly different steps. But each takes about two to four hours and follow a similar overall procedure. Here’s a general overview of a fundoplication surgery:

1. Several small cuts are made through the skin and peritoneum, a layer of tissue around your gut.
2. A thin, lighted tube with a camera and tiny surgical tools are inserted into the cuts.
3. Your fundus is wrapped around tissue from your lower esophagus.
4. Dissolvable stitches are used to attach the fundus to your esophagus.
5. Any gas in the abdomen is vented out and all tools are removed from the surgical site.
6. The cuts are closed with dissolvable stitches.

Here’s what to expect during your recovery:

• You’ll go home about 36 to 48 hours after surgery. You may need to stay in the hospital for up to a week if you had an open surgery.
• You’ll have some surgical dressings or adhesive strips over your incisions. These stop bleeding and drainage. They can be removed about two to seven days following surgery.
• You may need to receive food through a gastrostomy tube. This may be the case for some time after a fundoplication. Your doctor will give you instructions for use, and you’ll likely get supplies and food sent to your home. You may not need the tube after a few weeks. But if you need the tube permanently, you’ll work with your doctor or gastrointestinal (GI) specialist to learn how best to use it.
• You can take acetaminophen (Tylenol) or ibuprofen (Advil). These can relieve pain or discomfort after you leave the hospital. If these don’t help, your doctor may prescribe a stronger medication.
• Don’t bathe right away. Wait about two days or until after dressings are removed.
• Clean your incisions with warm, clean water and a gentle, unscented soap. Your surgeon will probably use dissolvable stitches under the skin that don’t need to be removed. See your doctor right away if the incisions get redder and more irritated or leak pus during the first two weeks after surgery.
• Take a few days off. Wait until your doctor says it’s fine to drive, return to work, or do regular activities. This is usually about three to seven days after you get out of the hospital.
• Go to follow-up appointments. If required, see your doctor to make sure your incisions are healing properly and you aren’t experiencing any complications.

You may need to make changes to your diet to prevent any long-term discomfort or complications after this procedure.

Here’s an outline of what to expect over the first few months as well as how your diet may change permanently:

• 2 weeks after surgery. Eat soft or liquid foods, including yogurt, soup, and pudding. Only drink beverages like water, milk, and juice — don’t drink soda or carbonated beverages that can increase gas buildup in your stomach.
• 3 to 4 weeks after surgery. Slowly introduce solid — yet still softened — foods back into your diet. Try pasta, breads, mashed potatoes, peanut butter, and cheese.
• 1 to 3 months after surgery and beyond. You’ll be able to gradually return to the diet you had before. You may want to stop eating foods that can get stuck in your esophagus, such as steak, chicken, or nuts.

Some reported complications of fundoplication include:

• piercing of the lining or walls in your esophagus, stomach, or tissues around your lungs, which is more likely during laparoscopic procedures
• infection of the surgical site
• stitches breaking open and exposing the surgical area
• lung infections, such as pneumonia
• having trouble swallowing
• dumping syndrome, when food travels too fast from your stomach to intestines
• nausea and gagging
• gas buildup in your stomach
• inability to throw up when needed
• reflux continuing to happen
• needing follow-up surgery

Fundoplication is a highly effective surgery for treating GERD, reflux-related symptoms, and hiatal hernias.

Talk to your doctor about which type of fundoplication will work best for you. Some techniques have a higher chance of complications or may require follow-up surgery: