MEDICAL PROCEDURES
Fundoplication
(Anti-Reflux Surgery)
What is fundoplication?
Fundoplication has been the standard surgical method for treating gastro-esophageal reflux disease ( GERD) . GERD causes inflammation, pain (heartburn), and other complications (such as scarring and stricture of the esophagus). GERD results when acid refluxes (regurgitates, or backwashes) from the stomach back up into the esophagus. Under normal conditions, there is a barrier to acid reflux. One part of this barrier is the lower-most muscle of the esophagus (called the lower esophageal sphincter). Most of the time, this muscle is contracted (constricted, or tight), which closes off the esophagus from the stomach. In patients with GERD, the sphincter does not function normally. The muscle is either weak or relaxes inappropriately. Fundoplication is a surgical technique that strengthens the barrier to acid reflux when the sphincter does not function normally.
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 are frequently 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 may also be tightened. Fundoplication may be done using a large incision ( laparotomy or thoracotomy ) 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, it presently is being challenged by endoscopic methods. 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. In a third method, inert material is injected within the sphincter, also tightening the sphincter. All three methods reduce acid reflux.
Endoscopic methods offer a simpler way of treating GERD than fundoplication. However, it is too early to say how effective, safe, or long-lasting the endoscopic methods will be.
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