Antireflux, Laparoscopic Fundoplication

A surgical procedure for the treatment of gastro-oesophageal reflux. The Fundus (top of the stomach) is wrapped around the bottom of the oesophagus in order to strengthen and support the lower oesophageal sphincter, a muscle that prevent reflux of the gastric contents up to the oesophagus.

Surgical Procedures

Nissen (360°)

The fundus is wrapped three quarters of the way around the intra-abdominal oesophagus and sutured at the front.

Toupet (270°)

The fundus is wrapped three quarters of the way around the intra-abdominal oesophagus and sutured at the sides.

Anterior / Dor Procedure (180°)

A loose wrap usually performed on patients with decreased peristalsis of the esophagus.

Other procedures requiring a laparoscopic fundoplication:

  • Laparoscopic Heller’s Cardiomyotomy – muscle fibers of the lower esophagus are split and a fundoplication is then performed.
  • Laparoscopic Para-oesophageal Hernia repair – is the reduction of a rolling type hiatus hernia with a diaphragmatic repair with or without a mesh and a laparoscopic fundoplication.

What to expect after your operation

  • After a general anaesthetic, you may be drowsy.
  • You may have general neck / throat ‘soreness’.
  • Will most likely have a dry mouth.
  • A nurse will monitor your vital signs – blood pressure, pulse, temperature, respirations and oxygen saturations regularly for the first 4 hours post-operatively.
  • The nurse will also ask you to rate your pain on a scale of 0 – no pain to 10 – worst pain imaginable and administer pain relief medication as necessary
  • After your procedure, you will NOT be able to eat or drink for four (4) hours - then you will commence on a clear fluid diet.
  • If you tolerated clear fluids your diet will be upgraded to Free Fluids at the next mealtime.
  • If you tolerated free fluids your diet will be upgraded to a special diet Laparoscopic Nissens Fundoplication diet (LNF). You will need to remain on this diet for 4 weeks (see additional handout).
  • If you tolerate this diet you will be able to go home.

Post-operative period

  • You will have an intravenous Cannula ‘drip’.
  • There will be 5 small incisions on your abdomen all dressed with waterproof dressings.
  • You may have nausea, shoulder tip pain or abdominal bloating.
  • Occasionally, there can be some numbness and / or swelling at the incision sites.

Length of stay in hospital

Please try and have transport arranged for your discharge the day after surgery unless otherwise instructed - Discharge time will be after lunch if admitted for 1 night and will be after breakfast if admitted for 2 nights.

Discharge planning – going home 

Following your discharge, it is very important that you give yourself time to recuperate and heal - Follow the dietary guidelines slowly upgrading the texture of your diet, you should be able to tolerate a full diet by 5-6 weeks - It will be difficult to belch, so where possible you should avoid ‘fizzy’ drinks.

You may have increased flatus ‘wind’, abdominal cramps, diarrhoea or constipation following this procedure.

Wound Care – Leave dressings on for 7 days post discharge, then remove and wash wound in shower. All stitches are underneath the skin, so nothing has to be removed. Observe for signs of infection such as increased redness, swelling, pain, ooze or heat and report to local GP or emergency department.

Be sure to take all prescribed medications.

You will need to make an appointment for 4 weeks to see Dr Daoud.

Risks

  • Esophageal injury.
  • Bleeding.
  • Bowel injury and other visceral injury.
  • Spleen injury, which may require losing the spleen.
  • Migration of the fundal wrap into the chest which requires an emergency surgery.