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Fundoplication Information & Informed Consent
Informed Consent of Fundoplication surgery for gastroesophageal reflux disease (GERD)
During fundoplication surgery, the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place so that the lower portion of the esophagus passes through a small tunnel of stomach muscle. This surgery strengthens the valve between the esophagus and stomach (lower esophageal sphincter), which stops acid from backing up into the esophagus as easily. This allows the esophagus to heal.
This procedure can be done through the abdomen or the chest. The chest approach is often used if a person is overweight or has a short esophagus.
This procedure is often done using a laparoscopic surgical technique. Outcomes of the laparoscopic technique are best when the surgery is done by a surgeon with experience using this procedure.
If a person has a hiatal hernia, which can cause gastroesophageal reflux disease (GERD) symptoms, it will also be repaired during this surgery.
What To Expect After Surgery
If open surgery (which requires a large incision) is done, you will most likely spend several days in the hospital. A general anesthetic is used, which means you sleep through the operation. After open surgery, you may need 4 to 6 weeks to get back to work or your normal routine.
If the laparoscopic method is used, you will most likely be in the hospital for only 1 or 2 days. A general anesthetic is used. You will have less pain after surgery because there is no large incision to heal. After laparoscopic surgery, most people can go back to work or their normal routine in about 2 to 3 weeks, depending on their work.
After either surgery, you may need to change the way you eat. You may need to eat only soft foods until the surgery heals, and you should chew food thoroughly and eat more slowly to give the food time to go down the esophagus.
Why It Is Done
Fundoplication surgery is most often used to treat GERD symptoms that are likely to be caused in part by a hiatal hernia and that have not been well controlled by medicines. The surgery may also be used for some people who do not have a hiatal hernia. Surgery also may be an option when:
How Well It Works
Studies show that laparoscopic fundoplication improves GERD symptoms in about 6 to 9 out of 10 people who have the surgery (depending on how experienced the surgeon is). But no studies have proven that laparoscopic fundoplication surgery is effective in maintaining healing of the esophagus over the long term. 
A successful surgery does not guarantee that you will never have symptoms again. Some studies show that only about 1 out of 10 people who have fundoplication surgery done by an experienced surgeon have symptoms come back in the 2 years after surgery.  But there isn't much research on how many people have symptoms come back after more than 2 years.
But compared to people who do not have surgery, people who do have surgery are less likely to need medicine every day and have less severe symptoms when they stop taking medicine. Also, people who have surgery for GERD seem to be happy with the results, even if their symptoms do come back and they have to take medicine again. 
About 2 or 3 out of 10 people who have surgery to relieve GERD symptoms have new problems (such as difficulty swallowing, intestinal gas, or bloating) after the surgery.  These new symptoms may or may not respond to treatment with medicines.
Risks or complications following fundoplication surgery include:
For some people, the side effects of surgery-bloating caused by gas buildup, swallowing problems, pain at the surgical site and dumping syndrome are as bothersome as GERD symptoms. The fundoplication procedure cannot be reversed, and in some cases it may not be possible to relieve the symptoms of these complications, even with a second surgery. Patients must consider these potential side effects and complications prior to deciding on surgery.
What To Think About
When fundoplication surgery is successful, it may eliminate the need for long-term treatment with medicine. When trying to decide between surgery and treatment with medicine, weigh the cost, risks, and potential complications of the surgery and the possible risk of complications against the cost and inconvenience of long-term, often lifetime, medication therapy.
Before surgery, additional tests will usually be done to be certain surgery is likely to help cure GERD symptoms and to diagnose problems that could be made worse by surgery.
Second surgeries are more difficult to do, are less successful, and are more risky. So, it is extremely important that the first procedure be considered carefully and be done by an experienced surgeon who is more likely to be successful the first time.
Surgery to treat GERD is rarely done on people who:
Complete the surgery information form (PDF) to help you prepare for this surgery.
|Last Updated ( Saturday, 30 May 2009 )|
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