Procedures

Gastroesophageal fundoplication

• Description
• Risks
• Pre operative information
• Information about the day of surgery

• Length of recovery
• Post operative information

Description:

The goal of a surgical procedure, called gastroesophageal fundoplication, is to: 1) Replace the esophagus and stomach into the abdominal cavity. 2) Repair any associated hiatal hernia. 3) Correct the dysfunctional lower esophageal sphincter by creating a collar of stomach around the lower esophagus to create a new valve. Only a small percentage of individuals with GERD will be a candidate for this operation, and include those who have refractory (persistent) symptoms after full dose medical treatment for reflux, and/or anatomic conditions where surgery is the preferred approach. Most antireflux operations can now be done laparoscopically, without a large incision in the abdomen.

Risks:

Like all surgical procedures, the operation does not always work and may have risks and complications. Specific risks for gastroesophageal fundoplication include: damage to liver, bowel, spleen, esophagus, stomach; vagus nerve, open surgery; recurrent reflux, dysphagia (difficulty swallowing), gas bloat syndrome, major artery.

Pre operative information:

For patients with severe GERD, where a surgical solution may be eventually considered, a referral will likely be made to a gastroenterologist. Diagnostic tests to document and/or verify GERD will usually include upper endoscopy, also called esophagogastroduodenscopy, or EGD. This allows direct visualization of the lining of the esophagus and stomach, and can document the presence of inflammation (esophagitis), ulcers, scarring, and the presence of Barrett’s esophagitis. The presence of a hiatal hernia as well, can frequently be diagnosed. It is an essential step in the preoperative evaluation for surgery. Barium swallow x-rays may also be utilized to determine the presence of a hiatal hernia or other esophagus abnormalities. The gastroenterologist may also perform a 24-hour pH probe study, where an acid detecting probe is placed in the lower esophagus to determine the degree of acid insult over a 24-hour period. If surgery is a strong consideration, then a final test called esophageal manometry, will test the muscle function of the esophagus as well as the competency of the lower esophageal sphincter (LES). In patients with severe GERD, where the diagnostic testing is felt to be convincing, referral on to a general surgeon may be considered for a surgical evaluation and possible operative repair.

Before your surgery, you will be required to have a pre admission testing appointment. At this appointment, you will be registered at the hospital; you will have lab work done and possibly a x-ray. You will also meet with an anestheologist.

Information about the day of surgery:

No food starting midnight the night before surgery. Solid food must be avoided the day of surgery-regardless of the surgery time. Clear liquids must be stopped four (4) hours before your surgery.

Clear liquids are considered: water, apple juice, cranberry juice, black coffee (no cream), tea, and soda (7-UP, pepsi, ect).

Length of recovery:

The hospital stay is usually 24-48 hours. There are restrictions on diet and activity for up to 4-weeks following the operation. A liquid diet can be started within a few hours of surgery. Solid food is usually withheld for 7-10 days and then soft foods are allowed. Most patients resume a regular diet 30 days after surgery. Light lifting is allowed within a week, and heavy activities by 2-3 weeks. Total or near total resolution of symptoms is a frequent outcome.

Post operative information:

Laparoscopic - Fundoplication Post-Surgery Guide

The following information is intended to guide you through your post-op recovery:

Diet:

For the first 2 weeks after surgery you need to follow a full liquid diet. A diet instruction sheet will be given to you at the office. Then if OK’d by your doctor, you will advance to a very soft diet. This diet includes soft cooked eggs, puddings, mashed potatoes, etc. We suggest you eat small frequent meals and drink your liquids 30-60 minutes after your meal.
HELPFUL HINTS: Take small bites or swallows, wait approximately 10-20 seconds between bites or swallows, and NO CARBONATED beverages for the first one to two months after your surgery.
NOTE: It is important that you do not begin to retch or vomit in the first few weeks after your surgery. If you feel nauseous during this period of time we would like you to notify our office so we can assist you. Office hours are 9:00am to 5:00pm Monday thru Friday.

Medications:

Follow the directions on any new prescriptions that your doctor has given you. You will be instructed prior to your discharge about what daily medications you will need to take when you return home.
Pain management is an important part of your post-surgery care. You should expect some discomfort after your surgery. You may be sent home with a prescription for pain medication. It is important to take your pain medicine prior to your pain becoming intense in severity.
PLEASE NOTE: No pain medication refills will be authorized on the weekends. If a refill is needed, the request must be made before 12:00 noon on Friday.
Some side effects from the pain medications include nausea and constipation. If you experience nausea or vomiting related to your pain medications, you should stop the medication and take ibuprofen or acetaminophen for pain management.

Bowel Care:

To prevent constipation you should drink plenty of fluids and take a stool softener daily.
If you have not had a bowel movement within 48 hours after your return home, you should increase your fluid intake. You may take one single dose of Milk of Magnesia, as long as you have no abdominal distention.

Incision Care:

Please leave your dressings on for 48 hours after your surgery. Unless your doctor specified otherwise you may then remove your dressing and shower. Remove the outer dressing and leave the strips of tape that cover your incision.
If your dressing becomes soiled, or loosens and comes off prior to 48 hours after surgery, you may replace it with a dry sterile dressing and tape.
You will have steri-strips of tape across your incision. Those strips should remain in place for 5-14 days. The strips will gradually loosen and come off. If they do not come off within 2 weeks you may remove them yourself.
You must observe your incision daily for signs or symptoms of infection. These signs would include: increased swelling, redness or smelly wound drainage. It is normal to have some swelling and bruising around your incision.

Bathing and Showering:

You may start showering 48 hours after your surgery. You may shower with your steri-strips and staples or stitches in place. Do not scrub across your steri-strips or staples. Do not bathe in a tub for 10-14 days after your surgery. This includes a “hot tub”.

Driving:

You may drive when you no longer are taking narcotic pain medications and you feel you can quickly respond to situations that will not place others in jeopardy.

Return to Work:

As a general guideline the following will give you a guide for when to return to work:
Light lifting or no lifting type jobs: You may return to work from a few days to one week post-surgery.
Heavy lifting or physical type jobs: You may return to work one week after surgery, with a weight/lifting restriction of no greater than 10-20# for 2 weeks total. If your job does not allow for light duty, then you will need to be off of work for 2 weeks after your surgery.

Follow-up Appointments:

You will need to return to the office for a follow-up visit usually within 2 weeks after your surgery. Please make sure you have your appointment scheduled.

Problems to Observe For:

Call the office for the following:
1. Fever >101.0
2. Uncontrolled pain. That is on a scale of 1-10 (10 being the worst pain imaginable) your pain is a level 7 or above.
3. Nausea and / or vomiting that continue for 12-24 hours.
4. Diarrhea that continues for 12-24 hours.
5. Signs of a wound infection.
6. Chest pain or difficulty breathing
7. Your incision separates or opens up.

If you have further questions after reading this handout, the office is open from 9:00AM to 5:00PM Monday through Friday. For emergencies after office hours, the answering service will be available when you call the office number.