Fundoplication is a type of surgery to correct problems with the lower esophageal sphincter (LES) associated with gastroesophageal reflux disease (GERD).

The procedure involves wrapping a portion of the stomach either partially or completely around the band of muscles at the base of the esophagus. This strengthens LES muscles, allowing the LES to properly close and preventing contents of the stomach from backing up into the esophagus (reflux).

Fundoplication is most often used to treat patients with GERD and associated conditions, such as esophagitis and hiatal hernia. Patients with complications of GERD, such as stricture and Barrett’s esophagus (that has not progressed to cancer) may also benefit from fundoplication.

The surgery is often recommended for patients whose symptoms do not respond to lifestyle modification (e.g., diet, exercise) or medications. Patients may opt for fundoplication to avoid a lifetime of anti-reflux medication, or they may be unable to tolerate such medication.

Fundoplication may be performed as an open surgery, in which organs are manipulated directly via an opening several inches long in the patient’s abdomen or chest. However, most are now performed laparoscopically, through the insertion of tools through several small (1 centimeter) incisions in the patient’s abdomen or chest. Laparoscopic fundoplications involve a shorter hospital stay, a shorter recovery period and less scarring than open procedures. Patients often experience less postoperative discomfort with laparoscopic surgery as well.

Patients may undergo various tests (e.g., blood tests, x-rays) to monitor their overall health and view the structure of their esophagus and stomach prior to surgery. They will be given general anesthesia which will put them to sleep for the procedure, which takes approximately two hours. Their vital signs will be monitored and if a hiatal hernia exists, it will be repaired during the procedure. Patients may remain in the hospital for up to three days (laparoscopic) or six days (open) following fundoplication, and may be fed through a feeding tube during that time.

Patients will require a liquid diet for the first week following the surgery. They will need to refrain from strenuous activity and arrange for follow-up care with their physician. Patients can usually return to work within three weeks (laparoscopic) or six weeks (open) of the surgery.

Fundoplication reduces or eliminates GERD symptoms in the majority of patients who undergo the surgery. Estimates vary, but most patients experience relief after fundoplication.

Any type of surgery carries risks, including bleeding and infection. Adverse reactions to anesthesia may also occur. With fundoplication, patients may experience postoperative symptoms such as gas-bloat syndrome (inability to belch or vomit) and dysphagia (difficulty swallowing). In addition, GERD symptoms may recur after surgery. In those cases, patients may require anti-reflux medications or additional surgery. Fundoplication does not prevent the risk of cancer for patients with GERD and Barrett’s esophagus.

Nonsurgical alternatives to fundoplication are available. One involves stitching the LES to reinforce it. Another involves creating scar tissue to strengthen LES muscles. Both may be performed in outpatient treatment facilities and involve the use of an endoscope, rather than incisions to a patient’s body.