Fundoplication is a type of laparoscopic anti-reflux surgery to treat gastroesophageal reflux disease (GERD). Doctors may recommend it for people with severe GERD.

If you have gastroesophageal reflux disease (GERD), the muscles that help move food down into your lower esophagus may be weakened. This includes the sphincter that closes the opening between your esophagus and stomach. Fundoplication can help strengthen this opening to prevent food and acid from going back up.

This procedure is usually successful and has a good long-term outlook, but it may not work for everyone with GERD. Keep reading to learn what recovery is like and how you may need to change your lifestyle to help keep your digestive tract strong.

Fundoplication is a surgical technique that re-creates lower esophageal sphincter pressure by wrapping your stomach’s fundus (the upper part of your stomach that bulges around your esophagus) around your esophagus. Different types of fundoplication involve different techniques.

Surgeons can use this procedure to treat multiple digestive conditions, including:

A doctor may recommend this procedure for you if you would otherwise need to take acid-suppressant medication long-term.

According to research published in 2023, laparoscopic anti-reflux surgery such as fundoplication is less likely to work for people with refractory GERD that has not responded to medication. This may include people who actually have other health conditions that cause symptoms similar to GERD.

Before surgery, doctors typically recommend testing to confirm the diagnosis of GERD and rule out other conditions that may worsen symptoms after surgery. This can include a pH impedance and a motility test.

After anti-reflux surgery, some people may still need to take medication for GERD.

Learn more about treatments for GERD.

Your surgical team will usually provide verbal and written directions to help you prepare for this procedure. Your specific guidelines may vary, but preparation instructions may include:

  • avoiding all food and drink after midnight the night before your operation
  • not smoking cigarettes for a few weeks before your surgery
  • not taking any medications the night before and the day of your surgery
  • arranging for a friend or family member to take you to and from the hospital

Before the procedure, your surgical team may give you antibiotics and other medications.

When you arrive at the hospital for the surgery, you will check in and change into a hospital gown.

Then, a healthcare professional will typically place 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. 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.

A laparoscopic procedure has a shorter recovery time and leaves smaller scars than an open procedure.

All types of fundoplication surgery take 2 to 4 hours and follow a similar overall procedure. Here’s a general overview of a fundoplication surgery:

  1. The surgery team makes several small cuts through your skin and peritoneum, a layer of tissue around your gut.
  2. They insert a thin, lighted tube with a camera and tiny surgical tools into the cuts.
  3. They wrap your fundus around tissue from your lower esophagus.
  4. They use dissolvable stitches to attach your fundus to your esophagus.
  5. They vent out any gas in your abdomen and remove all tools from the surgical site.
  6. They close the cuts with dissolvable stitches.

Types of fundoplication

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 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 (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 your esophagus next to your diaphragm is reconstructed. Then, the fundus is wrapped halfway around the front (anterior) of the bottom of your esophagus and attached to part of your diaphragm tissue.

Your recovery time after fundoplication can depend on individual factors and the type of procedure you have.

Here’s what to expect during your recovery:

  • You may need to stay in the hospital for a few days after surgery: If you had an open surgery, you may need to stay longer.
  • When you go home, you may still have surgical dressings or adhesive strips over your incisions: These stop bleeding and drainage. Your surgical team will tell you when they can remove them.
  • A doctor may recommend over-the-counter pain relievers: These can relieve pain or discomfort after you leave the hospital. If these medications don’t help, a doctor may prescribe a stronger medication.
  • You will likely need to wait to bathe: Your surgical team will let you know when you can get the surgical site wet.
  • Your stitches will likely dissolve on their own: Dissolvable stitches under your skin do not need to be removed. Contact your doctor immediately if the incisions get redder and more irritated or leak pus in the first 2 weeks after surgery. If you do not have dissolvable stitches, you may need another appointment to have them removed.
  • Take a few days off: Don’t drive, go back to work, or resume your usual activities until your doctor says it’s safe.
  • Go to follow-up appointments: You may have follow-up appointments to ensure that your incisions are healing and you aren’t experiencing any issues.

You may need to change your diet to prevent any long-term discomfort or complications after this procedure. After surgery, you’ll likely follow a clear liquid diet for a time. If you tolerate it well, the surgical team may have you follow a full liquid diet. The amount of time can vary depending on your surgeon’s recommendations and how well you tolerate food.

You can gradually return to your regular diet according to your surgeon’s guidelines. The following is an example, and your surgery team may have different recommendations:

  • 2 weeks after surgery: You may be able to eat soft or liquid foods, including yogurt, soup, and pudding. You can drink beverages such as water, milk, and juice, but you may need to avoid soda and other carbonated beverages, which can increase gas buildup in your stomach.
  • 3 to 4 weeks after surgery: You may be able to slowly reintroduce solid but softened foods such as 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 avoid some foods that can get stuck in your esophagus, such as steak, chicken, and nuts.

Complications are possible with any procedure.

Though they are uncommon, possible complications of fundoplication include:

  • piercing of the lining or walls in your esophagus, your stomach, or the tissues around your lungs (more likely during laparoscopic procedures)
  • infection
  • stitches breaking open and exposing the surgical area
  • lung infections such as pneumonia
  • difficulty swallowing
  • dumping syndrome, which involves food traveling too quickly from your stomach to your intestines (though this is rare)
  • nausea and gagging
  • gas buildup in your stomach
  • an inability to vomit when needed
  • ongoing reflux despite surgery

Fundoplication is an effective surgery to treat GERD, reflux-related symptoms, and hiatal hernias. Many people who have this surgery experience significant symptom relief, but it may not work for everyone with GERD symptoms.

Your doctor or surgical team can perform tests and let you know whether this procedure is likely to work for you.

Read more about surgery options for GERD.