fundoplicature

Fundoplication, sometimes called fundoplicature in non-English contexts, is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. The operation creates a new valve at the junction of the stomach and esophagus by wrapping the upper part of the stomach (the fundus) around the distal esophagus, thereby reinforcing the lower esophageal sphincter and restoring the angle of His. The goal is to reduce reflux and improve related symptoms.

Indications include chronic GERD with inadequate response to medical therapy, reflux esophagitis, Barrett's esophagus, large hiatal hernia, or complications of reflux. Preoperative assessment typically involves upper endoscopy, pH monitoring, and esophageal manometry to evaluate motility and anatomy; poor esophageal motility may influence the choice of wrap.

Most fundoplications are performed laparoscopically, with open surgery used in selected cases. The wrap type varies: Nissen (360-degree) wrap; Toupet (partial, usually 270-degree, posterior) wrap; and Dor (anterior, partial, about 180–200 degrees). The procedure is commonly combined with crural repair to tighten the diaphragmatic hiatus.

Outcomes: Many patients experience relief of GERD symptoms and improved quality of life, with reduced or stopped acid-suppressive medications. Long-term durability is favorable for many, but dysphagia, gas-bloat syndrome, and inability to belch or vomit can occur. Rare complications include wrap obstruction, esophageal injury, and wrap herniation.

History: The procedure was developed in the mid-20th century and has evolved with laparoscopic techniques, which are now standard in many centers.