Laparoscopic fundoplication is a standard procedure for surgical treatment of gastro-esophageal reflux disease (GERD). Normally, the lower esophageal sphincter (lower-most muscle of the esophagus) makes an obstruction to acid refluxes or backwashes from the stomach by contraction of muscles. In patients with GERD, this sphincter does not act properly resulting reverse flow of acids and other digestive fluid from the stomach to the mouth. Dr. Rudolf Nissen, in the 1950s, first explained fundoplication for treatment of the severe reflux esophagitis.
What is laparoscopic fundoplication?
Laparoscopic fundoplication is a minimally invasive surgical procedure performed to restore the normal function of the lower esophageal sphincter (LSG). Fundus of the stomach is placed on the left side of the esophagus. The main portion of the stomach is wound around the back of the esophagus and comes again to the front of the esophagus. Surrounding the esophagus in middle, the right end of the fundus is sutured with the left end of the fundus. After fundoplication, the portion of the fundus looks like a buttoned shirt collar in which the esophagus is neck and fundus muffled are the collars. The purpose is to create a one-way valve allowing food from the esophagus to the stomach and protect stomach acid and other digestive fluid to backwash to the esophagus in patients of GERD. Types of fundoplication surgery are:
Who are eligible for laparoscopic fundoplication?
Before selecting the eligible patient for laparoscopic fundoplication, it is necessary to examine patient’s esophageal motility study and ambulatory 24 pH-metry. Because all patients with GERD are not fit this surgery. Only a portion of the GERD patients who are having refractory or long-term symptoms can be considered as fit for laparoscopic fundoplication after obtaining the stated reports, that too be decided by a gastro surgeon.
What are the post-operative supervisions?
Following laparoscopic fundoplication surgery, a patient is usually kept in hospital for a night. When a patient starts drinking after a day’s observation he/she is discharged from the hospital. Patient has to follow a dietary restriction for two weeks and after reviewing the post-operative position, according to surgeon’s advice patient may advance his dietary chart. A patient can resume normal activity in one week.
Authored By Dr G Parthasarathy - Surgical Gastroenterologist, Hyderabad