Laparoscopic fundoplication is a type of stomach surgery performed to treat gastroesophageal reflux disease (GERD) and hiatal hernia. It is conducted through a series of small incisions and is classified as a minimally invasive operation. This type of laparoscopic surgery entails a repositioning of the upper part of the stomach so that the lower section of the esophagus crosses through a channel of stomach muscle.
A laparoscopic fundoplication is often known as a Nissen fundoplication, bearing the name of the German surgeon who invented the surgery. Rudolph Nissen first performed the procedure 1955 and named it gastroplication. As the surgery became more routinely performed throughout the 1970s, it was renamed after Nissen.
During laparoscopic fundoplication, the gastric fundus — the uppermost section of the stomach — is completely wrapped around the esophagus. It is then sewn into this new position, which allows the lower region of the esophagus to pass through a small conduit of stomach muscle. The process supports the valve that is located between the esophagus itself and the lower esophageal sphincter, preventing stomach acid from moving into the esophagus.
Laparoscopic fundoplications are most often performed as GERD treatments when other therapies have proved unsuccessful. GERD is characterized by gastric acids backing up into the esophagus, causing heartburn, vomiting, generalized pain, and occasional breathing problems. Hiatal hernias possess many of these same symptoms, and a laparoscopic fundoplication is a common first step in remedying the condition.
The surgery is conducted under a general anesthetic. Patients are usually only in the hospital for a day or two and can resume normal activities within a few weeks. After a laparoscopic fundoplication, most patients are advised to consume foods that are soft and easy to digest.
As with any surgery, there are risks to this type of procedure, though, by and large, it is considered exceptionally safe and successful. Complications of a laparoscopic fundoplication may include problems with swallowing due to the esophageal wrap being too tight, gas, bloating, or a possible return of GERD symptoms. Laparoscopic fundoplication is not reversible.
Laparoscopic fundoplication is the most commonly performed surgery to treat GERD and hiatal hernia. Even in patients who experience a return of GERD, the condition is typically milder and the patient usually does not require medication on a regular basis. The process is not ideal for all patients, however. Those of advanced age or with complicated preexisting health problems may not benefit from laparoscopic fundoplication. Also, individuals with poor or comprised peristalsis — the movement of muscles that pushes food through the digestive track — might not be considered ideal candidates as strong squeezing reflexes are vital to efficiently moving food through the esophagus.
