Fundoplication involves wrapping the bottom part of the oesophagus (also known as the gullet or food pipe) around the top of the stomach, and then stitching it to itself. This operation aims to create a new valve, thus preventing stomach contents from refluxing into the oesophagus. There are several different ways this can be done e.g. a 360 degree wrap is called a 'Nissen', a partial wrap at the front is called a 'Dor', there are also Watson, Hill and Toupet wraps. There is no clinical evidence that one of kind wrap is better than another and the success of the operation is mainly dependant on the skill of the surgeon.
This a laparoscopic or keyhole operation. The surgeon makes four or five small incisions in the abdomen and then passes instruments through these incisions. The instruments include a laparoscope which allows the surgeon to see what they're doing on a high definition screen. If a Hiatus Hernia (when part of the stomach is protruding through the diaphragm) is present this is repaired at the same time. This operation takes around 60 - 90 minutes.
As with any surgical procedure there are risks (including blood loss, damage to internal organs, etc.) during the operation but the chances of these occurring are very small. Side effects from the fundoplication can include difficulty swallowing and an inability to belch or vomit. These side effects will often resolve without treatment although being incapable of belching or vomiting can persist.
In well selected patients, fundoplication can be a good choice. Clinical data shows that the majority of patients no longer have to take medication having had the operation.
Studies have shown that, over time, the effect of the operation diminishes and that some patients’ symptoms return. Five years after the operation 20-30% of patients will have experienced a return of some of their symptoms and many of these will be taking medication once more. However, overall quality of life still appears to be better in patients who have had surgery than in those who have not. In addition, clinical data shows that up to 10% of patients may need a further operation within 4 years.
Some patients can return home on the day of surgery and virtually everyone else is able to do so the following day. Most people find they are able to resume the majority of their normal activities 2-3 weeks after surgery.
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