Fundoplikation

Fundoplication, also known as fundoplikation in some languages, is a surgical procedure used to treat gastroesophageal reflux disease (GERD) and hiatal hernia. The goal is to reinforce the function of the lower esophageal sphincter by wrapping the upper part of the stomach (the fundus) around the distal esophagus, thereby reducing reflux of gastric contents into the esophagus.

Most fundoplications are performed laparoscopically, though open surgery may be used in certain cases such as large hiatal hernias, prior abdominal surgery, or intraoperative complications. The procedure typically includes reduction of a hiatal hernia, mobilization of the gastroesophageal junction, and construction of a wrap. Wraps can be complete (Nissen, 360-degree) or partial (Toupet, about 270 degrees posterior; Dor, about 180 degrees anterior). In some cases, the crura may be repaired to close the hiatus.

Indications include chronic GERD with symptoms not adequately controlled by medical therapy, erosive esophagitis, or complications such as Barrett’s esophagus. It may also be offered for paraesophageal hernia when symptoms persist or there is risk of complications. Contraindications include poor esophageal motility or other esophageal pathology that would make a full wrap intolerable, as well as noncorrectable severe comorbidity or unfavorable anatomy.

Outcomes and risks: Fundoplication can provide substantial relief of reflux symptoms and improved esophagitis and quality of life, but some patients may experience persistent dysphagia, gas-bloat syndrome, or inability to belch or vomit. Complications can include bleeding, infection, injury to surrounding structures, wrap herniation, or need for revision in rare cases. Long-term follow-up is sometimes required.

Postoperative care typically involves a gradual diet progression, activity restrictions, and regular follow-up to assess symptoms.