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Alternative Names Return to topFundoplication; Nissen fundoplication; Belsey (Mark IV) fundoplication; Toupet fundoplication; Thal fundoplication; Hiatal hernia repair; Endoluminal fundoplication
Definition Return to top
Anti-reflux surgery is surgery to correct a problem with the muscles at the bottom of the esophagus (the tube from your mouth to the stomach). Problems with these muscles allow gastroesophageal reflux disease (GERD) to happen.
This surgery can also repair a hiatal hernia.
Description Return to top
GERD is a condition that causes food or stomach acid to come back up from your stomach into your esophagus. This is called reflux. It can cause heartburn and other uncomfortable symptoms. Reflux occurs if the muscles where the esophagus meets the stomach do not close tightly enough.
A hiatal hernia occurs when the natural opening in your diaphragm is too large. Your diaphragm is the muscle and tissue layer between your chest and belly. Your stomach may bulge through this large hole into your chest. This bulging is called a hiatal hernia. It may make GERD symptoms worse.
A procedure called fundoplication is the most common type of anti-reflux surgery. During this procedure, your surgeon will:
Surgery is done while you are under general anesthesia (asleep and pain-free). Surgery usually takes 2 to 3 hours.
Ways your doctor may do this surgery are:
Endoluminal fundoplication is a new procedure that uses a special camera called an endoscope. The tube is passed down through your mouth and into your esophagus. Your doctor will place small clips on the inside where the esophagus meets the stomach. These clips help prevent food or stomach acid from coming back. An endoscope is similar to a laparoscope. This procedure is done to help prevent reflux.
Why the Procedure is Performed Return to top
Your doctor may suggest surgery when:
Risks Return to top
Risks for any anesthesia are:
Risks for any surgery are:
Risks for this surgery are:
Before the Procedure Return to top
Your doctor may ask you to have these tests:
Always tell your doctor or nurse if:
During the week before your surgery:
On the day of your surgery:
After the Procedure Return to top
Patients who have laparoscopic surgery usually spend 1 to 3 days in hospital. Those who have open surgery may spend 2 to 6 days in the hospital after the procedure.
Most patients go back to work 2 to 3 weeks after laparoscopic surgery and 4 to 6 weeks after open surgery.
Outlook (Prognosis) Return to top
Anti-reflux surgery repair is a safe operation. Heartburn and other symptoms should improve after surgery. But you may still need to take drugs for your heartburn after surgery.
Some people will need another operation in the future to treat new reflux symptoms or swallowing problems. This may happen if the stomach was wrapped around the esophagus too tightly, the wrap loosens, or a new hiatal hernia develops.
References Return to top
Brant K. Oelschlager BK, Eubanks TR, Pellegrini CA. Hiatal Hernia and Gastroesophageal Reflux Disease. In: Townsend: Sabiston Textbook of Surgery, 18th ed. Philadelphia, PA:WB Saunders; 2007:chap 42.
Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383-1391.
Wilson JF. In The Clinic: Gastroesophageal Reflux Disease. Ann Intern Med. 2008;149(3):ITC2-1-15.Update Date: 2/7/2009 Updated by: George F Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.