Acid Reflux Surgery (Fundoplication)

Your doctor may recommend acid reflux surgery (fundoplication) to treat severe gastroesophageal reflux disease (GERD) that damages the esophagus. GERD occurs when the muscles of the esophagus do not close the opening to the stomach tightly enough. This causes reflux in which stomach contents back up into the esophagus. GERD is characterized by chronic heartburn, vomiting, coughing and wheezing. 

Acid reflux surgery also treats hiatal hernia, a condition in which part of the stomach pushes up through an opening in the diaphragm called the hiatus.

Your doctor will only consider acid reflux surgery if other treatment options that involve less risk of complications have been ineffective, such as medication.  Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on acid reflux surgery.

A general surgeon performs acid reflux surgery (fundoplication). General surgeons specialize in the surgical care of diseases, injuries and deformities affecting the abdomen, breasts, digestive tract, endocrine system and skin. 

Your acid reflux surgery will be performed in a hospital. Your surgeon will make a large incision or series of small incisions in your upper abdomen. With fundoplication, the upper part of the stomach is wrapped and stitched around the bottom of the esophagus. This tightens and reinforces the opening of the esophagus and prevents stomach contents from backing up into the esophagus. 

Surgical approaches to acid reflux surgery

Your surgeon will perform acid reflux surgery using one of the following approaches:

• Laparoscopic fundoplication is minimally invasive surgery. It involves inserting special instruments and a laparoscope through three or four small incisions in the upper abdomen. The laparoscope is a thin, lighted instrument with a small camera. The camera sends pictures of the inside of your body to a video screen that your surgeon sees while performing surgery. Another surgery option is to pass an instrument called an endoscope through your mouth and into your esophagus. Your surgeon sees the inside of your stomach on the video screen while tightening the end of your esophagus with stitches. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make small incisions, or no incisions at all, instead of a larger incision used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.

• Open surgery involves making a larger incision in the upper abdomen. An open surgery incision allows your doctor to see and access your stomach directly. Open surgery allows your doctor to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

Surgeons sometimes combine a minimally invasive procedure with an open surgery. They sometimes decide after beginning a minimally invasive procedure that an open surgery is needed to safely and most effectively complete the surgery. 
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different acid reflux surgical procedures and ask why your surgeon will use a particular type for you.

Types of anesthesia that may be used

Your surgeon will perform acid reflux surgery using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. 

You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

What to expect the day of your surgery

The day of your surgery, you can expect to:

• Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

• Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

• Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.

• A surgical team member will start an IV. 

• The anesthesiologist or nurse anesthetist will start your anesthesia.

• A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

• The surgical team may also insert a catheter in your bladder to monitor your urine output. They will also insert a tube through your mouth or nose into your stomach. This keeps your stomach empty during surgery. You will not feel or remember this or the surgery. 

• The surgical team will monitor your vital signs and other critical body functions. This occurs throughout surgery and recovery until you are alert, breathing effectively, and vital signs are stable.

As with all surgeries, acid reflux surgery (fundoplication) involves risks and possible complications. Most acid reflux surgeries are successful, but complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

General risks of surgery 

The general risks of surgical procedures include: 

• Anesthesia reaction, such as an allergic reaction and problems with breathing

• Bleeding, which can lead to shock

• Blood clot, which can reduce blood flow to your legs or feet or travel to your lungs and cause a pulmonary embolism

• Infection
  

Potential complications of acid reflux surgery

Complications of acid reflux surgery include:

• Collapsed lung

• Damage to blood vessels or organs, such as the esophagus, stomach, small intestine, lungs, spleen, or liver

• Difficulty burping 

• Difficulty swallowing, which usually fades one to three months after surgery

• Gagging, retching and vomiting

• Stomach bloating

• Unwrapping of the fundoplication, leading to a recurrence of reflux

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

• Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery

• Informing your doctor if you are nursing or there is any possibility of pregnancy

• Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage 

• Taking your medications exactly as directed

• Telling all members of your care team if you have any allergies

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.

You can prepare for acid reflux surgery by:

• Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

• Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include an endoscopy, a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.

• If you are overweight, talk to your doctor about losing weight before surgery through a healthy diet and exercise plan.

• Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

• Showering as directed before the surgery

• Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

• Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before acid reflux surgery  and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

• Why do I need acid reflux surgery? Are there any other options for treating my condition?

• What type of acid reflux surgery (fundoplication) procedure will I need?

• How long will the procedure take? When can I go home?

• What restrictions will I have after the surgery? When can I expect to return to work and other activities?

• What kind of food can I eat after surgery?

• What kind of assistance will I need at home?

• Will I need physical therapy or rehabilitation?

• What medications will I need before and after the surgery? How do I take my usual medications?

• How will you treat my pain?

• When should I follow up with you?

• How should I contact you? Ask for numbers to call during and after regular office hours.

Knowing what to expect can help make your road to recovery after fundoplication as smooth as possible. 

How long will it take to recover?

You will stay briefly in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. 

You may have a tube in your mouth or nose into your stomach. This tube releases air and drains fluid from your stomach until your body is able to process these substances by itself. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.

You will stay in the hospital for two to five days after acid reflux surgery. During this time, your surgical and medical teams will monitor your healing and help you gradually transition back to eating and drinking. You will be given clear liquids within a day. If you can tolerate those, you will drink thicker liquids and then solid foods. There are foods and drinks, such as soda, that you will need to avoid after your procedure.

Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, your general health, age, and other factors.

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor and will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up appointments after acid reflux surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

• Bleeding from your incision(s), vomiting blood, or bleeding from your rectum, including black, tarry stools

• Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

• Change in alertness, such as passing out, unresponsiveness, or confusion

• Chest pain, chest tightness, chest pressure, or palpitations

• Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

• Inability to urinate, have a bowel movement, or pass gas

• Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot

• Pain that is not controlled by your pain medication, new pain, or severe abdominal pain

• Sudden and new abdominal swelling

• Unexpected drainage, pus, redness or swelling of your incision

How might fundoplication affect my everyday life?

Acid reflux surgery may cure your condition or significantly reduce your symptoms so you can lead an active, normal life. For example, acid reflux surgery may help relieve severe heartburn or abdominal pain and allow you to resume eating many of the foods you love. Many patients are able to stop taking heartburn medications after acid reflux surgery.