Fundoplication

fundoplication

Fundoplication or Nissen Fundoplication is an effective procedure offered as a solution to disorders like Gerd and Hiatal hernia. Those who suffer severely from acid reflux and doesn’t get relief from medications, Fundoplication surgery is one of the many options they can opt for. Let’s first know about what GERD and Hiatal hernia is and what are the causes and symptoms.

What is Gerd and Hiatal Hernia?

Gastroesophageal reflux disease, GERD is a digestive disorder which occurs due to acid backing up into the oesophagus and attacking its lining.

Hiatal hernia refers to the condition in which upper part of stomach force its way through a gap in the centre of the diaphragm (normally lies on top of the stomach). This causes an abnormality in the lower oesophageal sphincter whose purpose it is to keep acid in the stomach and prevent its backflow to the oesophagus where it would otherwise cause heartburn.

However, most of the GERD sufferers have a hiatal hernia. Resorting to fundoplication surgery is the best treatment for GERD as well as Hiatal hernia.

What causes them?

The conditions are a cause of dysfunctional, or weak, lower oesophageal sphincter (LES). The LES is a muscle at the lower end of the oesophagus, which acts as a one-way valve to allow food to travel from the oesophagus to the stomach. The improper functioning of this valve causes the gastric acid in the stomach to splash up into the oesophagus causing GERD. This can damage the oesophagus wall severely. Similarly, the dysfunction of this valve leads to a hiatal hernia.

GERD may also be caused due to

  • Too much intake of spicy foods, high-fat content food, tobacco, alcohol, smoking.
  • Undergoing certain medications
  • Pregnancy
  • Overactive stomach

What are the common symptoms?

Symptoms such as burning sensation around the chest area, chest pain, trouble swallowing, vomiting, frequent periods of coughing, severe hoarseness of the voice, are all signs of GERD.

If not treated on time, Gerd can lead to severe chest pain, damage to oesophagus lining, ulcers and bleeding in the oesophagus. Gerd can further trigger health conditions like asthma or even oesophagus cancer. Fundoplication is the best treatment to relieve you of the GERD symptoms.

Lab tests

Barium X-ray, biopsy, endoscopy, are some test which confirms the GERD condition.

When to consider Fundoplication?

Your doctor will prescribe you some medications at the initial stage. When medication does not work and lifestyle changes fail, your medical professional will suggest you the Fundoplication surgery. Since the surgery involves risks, you should consider it only when other treatments don’t work. You can also go for surgery when there is severe inflammation of your oesophagus or a narrowing of your oesophagus.

What Happens in a Fundoplication?

Fundoplication surgery is a laparoscopic procedure used to strengthen the lining of the oesophagus and stomach using some of the portion of the stomach. Laparoscopy is an instrument that helps in transmitting the images from the stomach to the computer screen to enable the surgery process. In this procedure, the small incisions are made in the abdomen. The upper portion of the stomach, called the fundus, is wrapped tightly around the lower portion of the oesophagus (LES) and stitching it. These sutures act like a rubber band keeping the LES tightly closed, when not in use to   acid refluxing and when in use, it allows enough flexibility for food to pass into the stomach. As a result, effect, this prevents the reflux of gastric contents into the oesophagus, thereby providing relief from the symptoms associated with the disorder.

Complications

Intestinal gas and the inability to burp, inability to vomit and bloating are a few risk factors involved in the procedure. Muscle spasms are also a side effect of the procedure, and this can be very painful to the patient. The patient may also feel difficulty in swallowing and might not be able to eat solid foods during this time, so it is best to switch to a liquid diet until his bowel function returns to normal.

To avoid complications from Fundoplication, frequent follow-ups must be done to ensure that there is no problem after a fundoplication. Information regarding what to do and what to eat and what to avoid after a fundoplication is also vital.

The patient must avoid eating large meals and must lie down for at least 30 minutes after eating to avoid dumping syndrome because of the reduced size of the stomach.

Avoid straining and bending, as this puts pressure on the abdomen and the surgical site and prefer eating food rich in fibre.

Recovery after a Fundoplication

Like any other surgery, fundoplication surgery can cause discomfort to the patient in the immediate post-operative period. The patient might feel pain at the surgical site. You will be hospitalized for a couple of days and you’ll be able to resume normal activity within a week or two.