FUNDOPLICATION PROCEDURE

What is the Nissen Fundoplication?

The Nissen Fundoplication is a procedure that involves freeing the lower esophagus and upper stomach.  The upper portion of the stomach is then brought around/ behind the esophagus and is sutured to itself creating a 360 degree wrap around the lower esophagus. The Nissen Fundoplication works by providing circumferential pressure reinforcement to the lower esophageal sphincter.  When an individual swallows air, liquid, or food; the wrap fills and transmits pressure around the esophagus.

Who is a candidate for a Nissen Fundoplication?

The Nissen fundoplication is still considered to be the Gold Standard in patients with normal esophageal function.  However, due to its negative side effect profile, it has largely been replaced in my practice by the LINX procedure.

What is the Toupet Fundoplication?

The Toupet Fundoplication is a procedure that involves freeing the lower esophagus and upper stomach.  The upper portion of the stomach is then brought around/ behind the esophagus.  The stomach is then sutured to the wall of the esophagus at the 10:00 and 2:00 positions.  This creates a wrap of roughly 270 degrees around the esophagus.  The Toupet Fundoplication reinforces the lower esophageal sphincter (LES) pressure.  When an individual swallows air, liquid, or food; the wrap fills and transmits pressure around the esophagus. The Toupetpartial Fundoplication was initially developed as an alternative to the Nissenfundoplication in order to avoid its side effects such as gas/bloat syndrome.  

Who is a candidate for a Toupet Fundoplication?

The Toupet Fundoplication is generally used for patients with poor esophageal function.  It is also used for patients with normal esophageal function who either can’t have or don’t want a LINX procedure.

What is the Dor Fundoplication?

The Dor Fundoplication is a procedure that involves freeing the lower esophagus and minimal dissection of the upper stomach.   The upper portion of the stomach is over the esophagus anteriorly and then is sutured to the esophagus and hiatus.  This creates a wrap of roughly 180 degrees around the esophagus.  The DorFundoplication reinforces the lower esophageal sphincter (LES) pressure.  When an individual swallows air, liquid, or food; the wrap fills and transmits pressure around the esophagus.

Who is a candidate for a Dor Fundoplication?

The Dor fundoplication is primarily used for patients with small hiatal hernias and poor esophageal function.  Typically, these hernia repairs do not require the blood vessels between the stomach and the spleen to be divided.  In addition, it is commonly used in patients undergoing a Heller myotomy for Achalasia.

What should you expect after a Fundoplication Procedure?

A Laparoscopic Robotic Hiatal Hernia with a fundoplication to manage GERD is generally an out-patient procedure. It is performed under general anesthesia. However, I use the latest pain and nausea control techniques and most patients experience minimal symptoms afterwards.  Most individuals are able to eat normally within a few weeks of the surgery.  In general, everyone learns how to eat slowly and chew their food well!!