Laparoscopic Fundoplication

Surgery is an OPTION in the management of gastroesophageal reflux. It is NOT mandatory. It is not a life-saving procedure. For well selected patients it is however, a good, long-term option in the management of a chronic condition.  

Indications for Surgical Consultation

•incompletely controlled reflux symptoms on standard treatment

•controlled reflux in the young patient

•controlled reflux with marked medication dependence

•complications of reflux

Barrett’s change

Esophageal stricture

Recurrent aspiration

•(medication side effects)

•(medication expense)

Prerequisites

Endoscopy

•to rule out concomitant disease

•determine presence of complications

•determination of anatomy

Esophageal motility studies/24 H pH

•confirmation of diagnosis

•rule out other primary esophageal disease

Contraindications

•failure to confirm diagnosis of significant reflux

•concomitant medical disease contraindicating open operative procedure

•extensive prior upper abdominal surgery

•esophageal motility disorders

Outcomes from Surgery

•90%-good result-controlled reflux, no medication, minimal dysphagia. About 1% of patients per year, may require medications again due to loosening of the wrap.

•5-10%-Marginal result-occasional requirement for medication, moderate dysphagia.

•5%-FAILURE-Ongoing problems, not improved with surgery and potentially new difficulties with dysphagia, diarrhea, gas bloat syndrome

Postoperative changes

•Dysphagia-swallowing difficulties-universally present after surgery-due to swelling from procedure, usually resolves in 2-6 weeks, may take longer in about 3% of patients. Liquid diet with slow progression to solids. Small meals frequently. Consider supplementation with Boost, Ensure or Carnation instant Breakfast. Occasionally needs dilatation.  

•Weight Loss-usually due to decreased appetite as well as difficulties swallowing. Most people will loose 2-5kg (5-10lbs) temporarily.  

•Abdominal Bloating (Gas-Bloat Syndrome)-due to trapping of swallowed air which is not easily belched after fundoplication. Usually resolves with time, treated with gas binding agents or prokinetic drugs (Maxeran)

•Chest Pain-due to healing process at the operative site or to esophageal spasm. Treated expectantly, occasionally needs dilatation.