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Anti-reflux surgery

Fundoplication; Nissen fundoplication; Belsey (Mark IV) fundoplication; Toupet fundoplication; Thal fundoplication; Hiatal hernia repair; Endoluminal fundoplication; Gastroesophageal reflux - surgery; GERD - surgery; Reflux - surgery; Hiatal hernia - surgery

Anti-reflux surgery is a treatment for acid reflux, also known as GERD (gastroesophageal reflux disease). GERD is a condition in which food or stomach acid comes back up from your stomach into the esophagus. The esophagus is the tube from your mouth to the stomach.

Reflux often occurs if the muscles where the esophagus meets the stomach do not close tightly enough. A hiatal hernia can make GERD symptoms worse. It occurs when the stomach bulges through this opening into your chest.

Symptoms of reflux or heartburn are burning in the stomach that you may also feel in your throat or chest, burping or gas bubbles, or trouble swallowing food or fluids.

Images

Hiatal hernia - X-ray

Presentation

Hiatal hernia repair - series

I Would Like to Learn About:

Description

The most common procedure of this type is called fundoplication. In this surgery, your surgeon will:

Surgery is done while you are under general anesthesia, so you are asleep and pain-free. Surgery most often takes 2 to 3 hours. Your surgeon may choose from different techniques.

OPEN REPAIR

LAPAROSCOPIC REPAIR

ENDOLUMINAL FUNDOPLICATION

Why the Procedure Is Performed

Before surgery is considered, your health care provider will have you try:

Surgery to treat your heartburn or reflux symptoms may be recommended when:

Anti-reflux surgery is also used to treat a problem where part of your stomach is getting stuck in your chest or is twisted. This is called a para-esophageal hernia.

Risks

Risks of any anesthesia and surgery in general are:

Risks of this surgery are:

Before the Procedure

You may need the following tests:

Always tell your provider if:

Before your surgery:

On the day of your surgery:

Your provider will tell you when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

Most people who have laparoscopic surgery can leave the hospital within 1 to 3 days after the procedure. You may need a hospital stay of 2 to 6 days if you have open surgery. Most people can return to normal activities in 4 to 6 weeks.

Outlook (Prognosis)

Heartburn and other symptoms should improve after surgery. Some people still need to take drugs for heartburn after surgery.

You may need another surgery in the future if you develop new reflux symptoms or swallowing problems. This may happen if the stomach was wrapped around the esophagus too tightly, the wrap loosens, or a new hiatal hernia develops.

Related Information

Hiatal hernia
Heartburn
Stomach acid test
Esophagitis
Esophageal stricture - benign
Chronic
Community-acquired pneumonia in adults
Aspiration
Gastroesophageal reflux disease
Barrett esophagus
Surgical wound care - open
Anti-reflux surgery - discharge
Gastroesophageal reflux - discharge
Heartburn - what to ask your doctor

References

Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308-328. PMID: 23419381 www.ncbi.nlm.nih.gov/pubmed/23419381.

Mazer LM, Azagury DE. Surgical management of gastroesophageal reflux disease. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:8-15.

Richter JE, Friedenberg FK. Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 44.

Yates RB, Oelschlager BK, Pellegrini CA. Gastroesophageal reflux disease and hiatal hernia. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 42.

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Review Date: 9/15/2019  

Reviewed By: Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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