Following surgery your diet will need to be restricted for a few weeks to allow the swelling around the esophagus to resolve. Click HERE to see the post-operative diet instructions.
When performing a fundoplication it is possible to make the wrap too tight or too long. This can lead to trouble swallowing or an inability to belch. The resulting "gas bloat syndrome" is one of the common criticisms of this procedure, and if it occurs it can be significant enough to warrant re-operation, either to take the wrap down completely or convert it into a partial wrap, called a Toupet fundoplication. While the Toupet may offer lower risk of gas bloat and trouble swallowing, it may also be somewhat less effective at controlling reflux, and may not be as durable over the long-term.
If the wrap is made too loose it may not effectively stop reflux, or it can even slip down on to the stomach causing a partial obstruction. In some cases patients may have their reflux symptoms return months or even years after a fundoplication. This is usually the result of a recurrence of a hiatal hernia. Re-operation and repair of the recurrent hernia can generally be performed laparoscopically, but the risk of this type of re-do surgery is always greater than the original operation.
Historically, Anti-Reflux Surgery has been shown to provide very good control of reflux in over 90% of patients. The results are highly dependent on a number of factors, including the experience of the surgeon and appropriate patient selection. These procedures, called fundoplications, involve wrapping the upper portion of the stomach around the lower esophagus, which serves to strengthen the lower esophageal sphincter. The reinforced sphincter is better able to stop acid and food from backing up into the esophagus, and in most cases, fundoplications can eliminate the need for heartburn medication and significantly improve other GERD related symptoms. For more than two decades these procedures have been performed using a minimally invasive technique known as operative laparoscopy. The advantages include less scarring, less pain and quicker recovery. For these reasons, laparoscopic fundoplication have essentially replaced open surgery in all but a very few situations.
The most common type of anti-reflux operation is called a Nissen fundoplication, named for the German surgeon who first introduced the concept. The upper part of the stomach is wrapped completely around the lower esophagus creating a "donut" effect. This procedure has been the "gold standard" among antireflux operations for more than 50 years, and is often performed in conjunction with a hiatal hernia repair. While there has been much written and said about the risk of Laparoscopic Nissen fundoplication, it remains a very effective and safe procedure when performed by an experienced and dedicated laparoscopic surgeon.