Name of the Procedure:

Esophagogastric Fundoplasty Partial or Complete; Laparotomy

Summary

Esophagogastric fundoplication (often referred to as fundoplasty) is a surgical procedure where the top part of the stomach, known as the fundus, is wrapped around the lower esophagus to strengthen the valve between the esophagus and stomach. This specific procedure uses an open surgical approach called laparotomy, involving a larger incision in the abdomen to access the stomach and esophagus.

Purpose

The procedure aims to treat gastroesophageal reflux disease (GERD) and hiatal hernias, conditions where stomach acid frequently flows back into the tube connecting the mouth and stomach (esophagus). The expected outcomes are a reduction in acid reflux occurrences, prevention of stomach contents from traveling backward, and improvement of associated symptoms like heartburn.

Indications

• Chronic GERD not responding to medication
• Hiatal hernia causing severe symptoms
• Persistent reflux leading to esophagitis (inflammation of the esophagus)
• Barrett's esophagus, a condition where prolonged acid exposure causes changes in the esophageal lining
• Recurrent lung infections or asthma associated with severe acid reflux

Preparation

• Patients are usually instructed to fast (no food or drink) for at least 8 hours before the surgery.
• Medication adjustments may be necessary, including stopping blood thinners.
• Preoperative tests such as blood work, EKG, and possibly an upper GI endoscopy are generally required.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is completely unconscious and pain-free.
2. Incision: A large incision is made in the abdomen to access the stomach and esophagus.
3. Exposure: The abdominal organs are carefully exposed, and the surgeon identifies the lower esophagus and stomach.
4. Fundoplication: The top part of the stomach (the fundus) is wrapped around the lower esophagus. This wrap can be partial (hemifundoplication) or complete (Nissen fundoplication).
5. Secure: The wrap is sutured in place to reinforce the valve between the esophagus and stomach.
6. Closure: The incision is closed with sutures or staples and covered with a sterile bandage.

Duration

The procedure typically takes 2 to 4 hours.

Setting

Performed in a hospital's surgical department.

Personnel

• Surgeons: Perform the operation.
• Anesthesiologists: Administer anesthesia and monitor the patient.
• Surgical nurses: Assist during the procedure.
• Operating room technicians: Provide support with surgical instruments.

Risks and Complications

• Common risks: Infection, bleeding, adverse reaction to anesthesia
• Rare risks: Damage to nearby organs (spleen, lung), difficulty swallowing (dysphagia), gas bloating syndrome, recurrence of reflux.

Benefits

• Significant reduction or complete alleviation of GERD symptoms
• Prevention of long-term complications from acid reflux, such as esophageal ulcers or Barrett's esophagus
• Improvement in quality of life

Recovery

• Hospital stay: Typically 2 to 5 days
• Post-procedure care: Pain management, gradual reintroduction of diet starting with liquids
• Expected recovery time: 4 to 6 weeks
• Restrictions: Avoid heavy lifting and strenuous activities for several weeks
• Follow-up: Appointments for monitoring and to assess recovery

Alternatives

• Lifestyle modifications: Diet changes, weight loss, avoiding alcohol and smoking
• Medications: Proton pump inhibitors (PPIs), H2 blockers
• Endoscopic procedures: Less invasive techniques like endoscopic fundoplication

Each alternative comes with pros and cons; medications and lifestyle changes may be less invasive but might not provide long-term relief expected from a surgical approach.

Patient Experience

• During: The patient will be under general anesthesia and will not feel any pain or discomfort during the procedure.
• After: Expect some pain and discomfort at the incision site, managed with pain medication. Gradual return to normal eating and activities will be advised.
• Pain management: Oral pain relievers, and sometimes stronger medications as needed.