Anti-reflux Surgery (Fundoplication) | Pristyn Care

Risk Factors

Risk factors for GERD requiring surgery:

• Obesity (BMI above 30)
• Hiatal hernia (especially large or paraesophageal)
• Connective tissue disorders
• Pregnancy causing repeated pressure on the diaphragm
• Prior oesophageal or gastric surgery
• Chronic lifestyle factors (smoking, alcohol, fatty diet)

Who Is a Candidate

Patients with GERD confirmed by pH monitoring or impedance testing, who have failed or are intolerant of PPI therapy, or who have complications such as Barrett’s oesophagus or severe erosive oesophagitis, are candidates for anti-reflux surgery.

Diagnosis

Pre-operative evaluation includes:

• Upper GI endoscopy with biopsy for oesophagitis, Barrett’s, and hiatal hernia assessment
• 24-hour ambulatory pH-impedance study to confirm abnormal reflux
• High-resolution oesophageal manometry to assess LES pressure and oesophageal motility
• Barium swallow for hiatal hernia and GEJ morphology
• Gastric emptying study if gastroparesis suspected

Treatment: Laparoscopic Fundoplication

Pristyn Care performs laparoscopic Nissen or Toupet fundoplication with hiatal hernia repair, tailored to oesophageal motility results. The procedure achieves lasting GERD control in over 90% of appropriately selected patients.

Fundoplication Procedure

Surgical procedure involves:

• Laparoscopic approach with 5 ports under general anaesthesia
• Reduction of any hiatal hernia and oesophageal mobilisation
• Crural repair with non-absorbable sutures (posterior hiatal closure)
• Mobilisation of gastric fundus by division of short gastric vessels
• 360 degree Nissen or 270 degree Toupet wrap construction around distal oesophagus
• Intraoperative endoscopy to confirm wrap position
• Drain placement and port closure

After the Surgery

Post-operative care includes:

• Liquid diet for 24-48 hours progressing to soft diet for 4-6 weeks
• Avoidance of carbonated drinks, bread, and hard meats initially
• Proton pump inhibitors tapered over 3 months
• Elevation of head of bed while sleeping
• Barium swallow at 6 weeks to confirm wrap integrity
• Follow-up endoscopy if symptoms persist or recur

Possible Complications of Fundoplication

Potential complications include:

• Dysphagia (usually temporary, resolves within 6-8 weeks)
• Gas-bloat syndrome from inability to belch
• Diarrhoea from vagus nerve manipulation
• Wrap disruption or herniation requiring revision
• Recurrent GERD (affects 10-15% at 10 years)
• Oesophageal or gastric perforation (rare)