Surgery, GERD (fundoplication)

A surgical technique that strengthens the barrier to acid reflux when the lower esophageal sphincter does not work normally and there is gastro-esophageal reflux.

Fundoplication has been the standard surgical method for treating gastro-esophageal reflux disease (GERD). GERD is the constellation of inflammation, pain (heartburn), and complications that results when acid refluxes (regurgitates) from the stomach back up into the esophagus. Under normal conditions, there is a barrier to acid reflux. One part of this barrier is the lower-most muscle of the esophagus (called the lower esophageal sphincter) which is contracted and closes off the esophagus from the stomach most of the time. In people with GERD, the sphincter does not work normally. It is weak or relaxes inappropriately, permitting the acid from the stomach to go back up into the esophagus.

During fundoplication, the part of the stomach closest to the esophagus is gathered, wrapped, and sutured around the lower end of the esophagus and the lower esophageal sphincter. This increases the pressure at the lower end of the esophagus and thereby reduces acid reflux. During fundoplication, other surgical steps frequently are taken that also may reduce acid reflux. If there is a hiatal hernia, the hernial sac may be pulled down from the chest and sutured so that it remains within the abdomen. The opening in the diaphragm through which the esophagus passes from the chest into the abdomen also may be tightened.

Fundoplication may be done using a large incision (in a laparotomy or thoracotomy) or with a laparoscope that requires only several small punctures of the abdomen. The advantage of the laparoscopic method is a speedier recovery and less post-operative pain.

The term fundoplication is composed of fundo-, referring to the fundus (the upper portion) of the stomach + -plication, an operation for reducing the size of a hollow organ (in this case, the stomach) by taking folds or tucks in its walls.