What is fundoplication?
It’s when the top of your stomach (called the fundus) is wrapped around the bottom of your oesophagus and stitched to itself. The aim is to form a high pressure zone that will strengthen your lower oesophageal valve (LOS) and stop stomach contents from moving back into your oesophagus.
The amount of stomach to be wrapped in front of or behind your oesophagus can vary. However, a 360 degree fundoplication, called the Nissen, is most common. The alternative procedures are termed as partial (180 or 270 degrees); including Dor, Watson, Hill and Toupet—named after the surgeons who first described them.
While they all possess theoretical advantages, there’s no strong evidence to support one above another. Success is mainly due to patient selection or the skill of the surgeon.
How is it performed?
Fundoplication is carried out through laparoscopic or keyhole surgery whereby your surgeon makes four or five small incisions in your abdomen before passing instruments through them. They include a laparoscope, which enables them to see what they are doing on a high definition screen. If a hiatus hernia (when part of your stomach protrudes through your diaphragm) is found, it will be repaired at the same time. The operation takes approximately 60–90 minutes.
What are the possible side effects/complications?
Any surgical procedure comes with risks although the chance of them occurring is small. However, fundoplication operations are known to cause side effects in many patients.
As the fundoplication is not a valve, it’s unable to open and close. Consequently, after surgery it can be difficult for patients to swallow and they may also be unable to belch or vomit, causing over 50% of patients to suffer significant bloating and wind symptoms. While these side effects may resolve without treatment, they can also be permanent.
Does it work?
When patients are carefully selected, fundoplication can be a great success. Clinical data illustrates that most have a better quality of life following the procedure, compared to those who are given medication, and that it is particularly effective at controlling heartburn and regurgitation symptoms.
However, there are also issues. Most commonly, it tends to fail over time because the stitches loosen with your oesophagus and stomach naturally moving around during eating. Eventually, the wrap may slip and reflux symptoms return. Hiatus hernias also tend to reoccur as they’re often brought on by a degenerative condition.
After five years, up to half of fundoplication patients will revert to anti-acid medication with some electing to go through another operation in an effort to eradicate their symptoms.
Does the effect last?
Studies have shown that, over time, the effect of the operation diminishes and that many patients’ symptoms return. Five years after the operation 25-50% of patients will have experienced a return of some of their symptoms and many of these will be taking medication once more.
However, overall quality of life still appears to be better in patients who had surgery than in those who have not. Clinical data shows up to 10% of patients may need a further operation within 5 years either because of symptom recurrence or problems with the fundoplication. It should also be explained that re-do surgery is inevitably likely to be more complicated than first time operations.