Fundoplication (cont.)
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
frequently are 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 also may be tightened.
Fundoplication may be done using a large incision (laparotomy
in the abdomen or thoracotomy
in the chest) 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.
Last Editorial Review: 3/31/2009
- Endoscopy (Esophagogastroduodenoscopy, EGD) - Learn about the endoscopy procedure which examines the esophagus, stomach and duodenum to detect gastrointestinal and digestive disorders on MedicineNet.com
- Gastroesophageal Reflux Disease (GERD, Heartburn) - Learn about gastroesophageal reflux disease (GERD, acid reflux, heartburn) symptoms like heartburn, chest pain, regurgitation, and nausea. Causes, diagnosis, treatment and prevention information is also included.
- Questions To Ask Before Surgery - Surgery questions to ask prior to having a procedure are important. Your surgeon should be available to answer your surgery questions prior to the procedure.
Latest Medical News
Digestion RSS