Fundoplication

Fundoplication is one of the most common surgical procedures. It is carried out with functional disorders and disorders of the anatomical structure of the lower esophageal sphincter, as well as with reflux, that is, the reflux of food and gastric juice into the esophagus, which leads to irritation and inflammation.

A disease of this kind can be congenital or acquired. Often the disease is associated with a hernia of the esophageal opening of the diaphragm, that is, the muscular border between the abdominal and chest cavities. Fundoplication is considered one of the “standards” of surgery and is performed in the vast majority of cases.

When is a fundoplication recommended?

The operation is most often prescribed: to eliminate serious problems with the esophagus, which have arisen as a result of prolonged exposure of gastric juice and food to the esophageal mucosa; for the correction and elimination of a hernia of the food opening of the diaphragm; to suppress attacks of heartburn and gastroesophageal reflux disease (GERD), which are observed after taking medications.

Possible postoperative complications and side effects of fundoplication

Fundoplication is a sure way to stop reflux, but does not exclude the occurrence of postoperative complications, which include:

• dysphagia or a disorder in the act of swallowing (in most cases it disappears within six months);
• ulcer of the gastric cuff;
• bloating;
• displacement of the fundoplication into the body of the stomach or into the chest;
• diarrhea;
• abdominal discomfort;
• heartburn;
• divergence of the fundoplication;
• chest pain and so on.

Most of the complications are due to the erroneous appointment of fundoplication due to incompetence, since there are a number of contraindications in which the operation is strictly not recommended.

Fundoplication is contraindicated in patients with uncoordinated motility, severe esophagitis, esophageal dysmotility, stricture, and shortening of the esophagus.

Preparing for the procedure

Before the fundoplication, a number of laboratory and diagnostic procedures are mandatory, as well as special patient preparation.

The following is used as a test:

• physical examination;
• manometry (a special test to measure muscle contractions of the esophagus in response to swallowing);
• daily pH monitoring;
• esophagogastroduodenoscopy (to visualize the state of the mucous membranes of the esophagus, stomach and duodenum, and, if necessary, to biopsy tissue samples);
• radiography of the gastrointestinal tract.

Before surgery, the patient must:

1. Consult on the use of drugs, a week before the proposed operation, you should stop taking the following drugs: clopidogrel, warfarin and other anticoagulants, anti-inflammatory drugs.
2. For 12 hours, refuse to eat and drink.
3. Arrange everything you need to recover at home after surgery.

Description of the procedure

General anesthesia is used for the operation.

Fundoplication is performed by laparoscopic and traditional methods. Preference is given to the first method. The essence of the operation is to create a five-centimeter “cuff” that will prevent reflux, as well as the subsequent development of esophagitis – irritation and inflammation of the esophagus.

To construct the cuff, the esophagus is encircled by the fundus of the stomach. Next, the legs of the diaphragm are sutured, as a result of which the diameter of the food opening decreases. The next step is to form a sleeve by connecting the posterior wall of the stomach with the anterior one. It encircles the abdominal esophagus. In parallel with this, to fix the created cuff and prevent recurrence, the membrane of the anterior wall of the esophagus is captured. As a result, the anterior wall of the stomach and the anterior abdominal wall are fixed with sutures.

During the operation, emptying improves and the number of transient relaxations during gastric distention decreases, the anatomical structure and functional state of the lower esophageal sphincter, its tone are restored.

The whole procedure, depending on the complexity and the presence of complications, can last within 2-4 hours.

Recovery and care advice

The recovery period after surgery is accompanied by discomfort. In order to improve the patient’s well-being, painkillers are prescribed.

The patient after fundoplication needs special care:

• you can walk with outside support only on the second day after the procedure;
• incisions should be cleaned regularly and covered with a dry and sterile dressing;
• during the bathing period, the place of the incisions is covered with a special waterproof film (it will be possible to wet the incisions only after a week);
• food is mostly liquid (diet “table number 1”);
• the doctor prescribes a course of treatment with anti-inflammatory and antibacterial drugs;
• it is important to follow all the recommendations of the doctor with maximum accuracy.

The full recovery period is six to eight weeks.

Complications after the procedure

You should immediately seek medical advice if the following symptoms bother you after surgery:

• severe chest pain, shortness of breath, cough;
• frequent urination with pain, burning and blood in the urine;
• pain in the abdomen that does not respond to the use of antispasmodic drugs;
• having difficulty swallowing;
• the presence of edema in the abdominal cavity;
• frequent bouts of nausea and vomiting that do not go away after taking appropriate medications;
• bleeding, swelling, redness, severe pain, suppuration of the incision;
• a variety of signs of infection, including chills and fever;
• other discomfort and pain symptoms.

Prevention of GERD development

Treatment for gastroesophageal reflux begins with lifestyle changes. First you need to find out what affects the occurrence of symptoms.

If you have symptoms of GERD, the following tips should be followed.

1. Avoid drinks and foods that relax the lower esophageal sphincter, such as mint, chocolate, and alcohol.
2. Get rid of excess weight. Being overweight and obese contribute to GERD, as being overweight increases pressure on the stomach and lower esophageal sphincter, which leads to acidic gastric juice being refluxed into the esophagus and irritating its mucosa.
3. Do not lie down for two or three hours after eating. After eating, it is recommended to take a walk. This not only prevents the onset of GERD symptoms, but also improves digestion and burns extra calories.
4. Avoid foods that trigger GERD symptoms. Avoid fried and fatty foods, mayonnaise, cream sauces or ice cream. Other foods that may exacerbate symptoms include tea, coffee, sodas, citrus fruits, and tomatoes.
5. Quit smoking. Smoking disrupts the digestive system and, according to some studies, the lower esophageal sphincter relaxes. As a result of smoking, the content of bicarbonate in saliva and its ability to protect the esophagus from stomach acid is reduced. Some types of nicotine replacement therapy (nicotine gum, nicotine patch) can cause stomach pain, indigestion, and vomiting. Before use, you should discuss with your doctor the possible side effects of nicotine substitutes.
6. Avoid wearing clothes that put pressure on your belly, such as tight jeans, tight belts, elastic waistbands, which increase pressure on the lower esophageal sphincter and stomach.
7. Elevate the head of the bed 15-20 cm or use a wedge-shaped pillow to allow acid to enter the stomach by gravity.
8. Do not bend over after eating. If you need to pick something up from the floor, it is better to sit on half-bent knees and try not to bend at the waist. Do not engage in sports and physical labor after eating.
9. Check the medications you are taking. Some medications can make symptoms worse. These drugs include calcium channel blockers, theophylline, anticholinergics, alpha-blockers, and beta-blockers. They may be present in Parkinson’s, asthma, and some over-the-counter cold and cough medicines. If you suspect the effect of the drug being taken on the symptoms, you need to discuss this with your doctor. Do not interrupt the prescribed treatment without consulting a doctor.

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