Laparoscopic fundoplication
Preparation:
As for general anaesthesia
Procedure:
Laparoscopic anti-reflux surgery involves enhancing the mechanisms that prevent the stomach contents refluxing back into the oesophagus. This means fixing a hiatus hernia, if it is present, and reinforcing the "valve" between the oesophagus and the stomach by wrapping the upper portion of the stomach around the lowest portion of the oesophagus.The amount of the stomach that is wrapped around the oesophagus varies according to the procedure performed and your surgeon will explain this in depth.
In a laparoscopic(“keyhole”) procedure, the surgeon will inflate the abdominal cavity with carbon dioxide, this allows the internal organs to fall away from the wall of the abdominal cavity and therefore creates space to allow the operation to take place. The laparoscope, which is connected to a tiny video camera, is inserted through a 10mm incision just above the umbilicus, giving the surgeon a magnified view of the patient's internal organs on a video monitor. Instruments are inserted through additional incisions to allow mobilisation of the oesophagus / stomach and stitching to take place. It is usual that there will be a total of 5 small incisions (5-10mm) required.
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Anaesthetic:
General
Post Operative Care:
Patients can start eating after recovery from anaesthesia but it is usual to start with liquids and build up to a soft diet. As with many laparoscopic procedures shoulder tip pain may be a problem over the initial post-operative period. Patients are generally mobile within the first 24 hours but it is likely to be 2 weeks before there is 100% return to daily activities. Patients are encouraged to engage in light activity while at home after surgery, building up gradually to normal over this initial 2 week period.
The vast majority of patients who undergo the procedure are either symptom-free or have significant improvement in their GORD symptoms. However in 10-15% of patients there will be one of the following complications of the procedure:
- Many patients develop temporary difficulty swallowing immediately after the operation. This usually resolves within one to three months after surgery but in a minority this persists.
- The ability to belch and/or vomit may be limited following this procedure. Some patients report stomach bloating.
- Rarely, some patients report no improvement in their symptoms
- In addition damage to the Vagus nerve at the time of surgery can result in diarrhoea but this is unusual.
OPC Codes: G2331
