Fundoplication
(Anti-Reflux Surgery)

Medical Author: Jay W. Marks, MD
Medical Editor: Dennis Lee, MD

• What is fundoplication?
• What happens during fundoplication?
• What are alternatives to fundoplication?

What is fundoplication?

Fundoplication has been the standard surgical method for treating gastro-esophageal reflux disease (GERD). GERD causes inflammation, pain (heartburn), and other complications (such as scarring and stricture of the esophagus). GERD results when acid refluxes (regurgitates, or backwashes) from the stomach back up into the esophagus. Under normal conditions, there is a barrier to acid reflux. One part of this barrier is the lower-most muscle of the esophagus (called the lower esophageal sphincter). Most of the time, this muscle is contracted (constricted, or tight), which closes off the esophagus from the stomach. In patients with GERD, the sphincter does not function normally. The muscle is either weak or relaxes inappropriately. Fundoplication is a surgical technique that strengthens the barrier to acid reflux when the sphincter does not function normally.

What happens during fundoplication?

During the fundoplication procedure, the part of the stomach that is closest to the entry of the esophagus (the fundus of the stomach) is gathered, wrapped, and sutured (sewn) around the lower end of the esophagus and the lower esophageal sphincter. (The gathering and suturing of one tissue to another is called plication.) This procedure increases the pressure at the lower end of the esophagus and thereby reduces acid reflux.

Also, during fundoplication, other surgical steps are frequently taken that also may reduce acid reflux. For instance, if the patient has a hiatal hernia (which occurs in 80% of patients with GERD), the hernial sac may be pulled down from the chest and sutured so that it remains within the abdomen. Additionally, the opening in the diaphragm through which the esophagus passes from the chest into the abdomen may also be tightened. Fundoplication may be done using a large incision (laparotomy or thoracotomy) or a laparoscope, which requires only several small punctures in the abdomen. The advantage of the laparoscopic method is a speedier recovery and less post-operative pain.

What are alternatives to fundoplication?

Although fundoplication is the standard surgical method for treating GERD, endoscopic methods for treating GERD have been developed. Endoscopy utilizes endoscopes, which are long flexible tubes that are swallowed by patients. The inside of the esophagus can be viewed through the endoscope and various instruments can be passed through channels in the endoscope. In one endoscopic method for treating GERD, an instrument is inserted that delivers an electrical current to the lower esophageal sphincter. This results in scarring which tightens the sphincter. In a second method, sutures are placed in the sphincter to tighten the sphincter. Other methods also have been employed experimentally. Although endoscopic methods offer a simpler way of treating GERD than fundoplication, there are many questions about how effective, safe, or long-lasting they are, and they are being performed and evaluated at a limited number of centers until these questions have been answered.

From the Doctors at MedicineNet.com

Gastroesophageal Reflux Disease (GERD, Heartburn) - Learn about gastroesophageal reflux disease (GERD, acid reflux, heartburn) symptoms like hearbrun, chest pain, regurgitation, and nausea. Causes, diagnosis, treatment and prevention information is also included. Source:MedicineNet Hiatal Hernia - Learn what a hiatal hernia is, causes, symptoms such as heartburn, nausea, and regurgitation. Read about the relationship to GERD, how it is diagnosed. Source:MedicineNet Esophagitis - Esophagitis symptoms include difficult and painful swallowing, heartburn, mouth sores feeling of something stuck in the throat, nausea and vomiting. Learn how to recognize esophagitis symproms, warning signs and treatment on MedicineNet.com. Source:WebMD Medical Reference from The Cleveland Clinic Read 15 more Fundoplication related articles ... So Much to Do, So Little Sleep Head Injuries All Too Common in Summer Play Health Tip: The Word on Wisdom Teeth Health Tip: Make Exercise a Daily Habit New Source of Heart Stem Cells Found Health Highlights: June 23, 2008 Poorer Patients Have Poorer Survival After Cancer Diagnosis One Gene May Be Key to Myeloma Crocodile Babies Cry Out for Hatching Immune Molecule Key to Preventing Organ Rejection