Introduction:
Gastro-oesophageal reflux disease is an established reflux of gastric acid or its contents into the esophagus. The esophagus is also called a food pipe. Gastroesophageal reflux diseases are standard and cannot be sufficiently controlled with lifestyle management and drug therapy. Therefore, the laparoscopic procedure of gastric fundoplication has been assumed as the primary surgical cure for patients not improved by medical treatment.
Gastroesophageal reflux disease can deplete the gastric muscle tightness that assists the passage of food downwardly into the stomach, which involves the sphincter that shuts the entrance between the esophagus and abdomen. Fundoplication is a procedure to support and reinforce the opening to prevent food and gastric acid from moving back into the esophagus. This approach is well accepted and has a better permanent outcome.
Nissen fundoplication is a surgical procedure for the treatment of gastroesophageal reflux disease. In this procedure, a sphincter is made at the lower esophageal end to control the acid and gastric content reflux back into the esophagus. This procedure, too, has a better outcome.
What Is Gastric Fundoplication?
Gastric Fundoplication is a surgical method that controls the reflux of gastric contents from pouring back into the food pipe. It is also known as the esophagus. Thus this is a treatment done surgically for gastroesophageal reflux disease and the hiatal hernia. In this procedure, they will cover the stomach's upper portion, almost the down part of the esophagus.
It develops pressure in the food pipe and can control the reflux of the gastric contents. This surgical management is only done if the other nonsurgical treatments are found to be not effective. Laparoscopic Nissen fundoplication is the generally achieved antireflux method. These methods are conducted via tiny incisions by the operator monitoring a video. While surgery, the upper portion of the stomach, is called the fundus; thus, it is called fundoplication.
It is enveloped almost at the esophagus base. Another word for the fundoplication is a wrap. It improves the valve at the esophagus end, which accomplishes work appropriately in patients with gastroesophageal reflux disease. Surgery helps manage reflux – digestive enzymes and acid- as resistance to gastroesophageal reflux disease drugs.
Thus, surgery can heal reflux better. In cases of hiatal hernia, this is corrected along with the Nissen fundoplication. Hiatal hernias appear when the organ on the top portion of the stomach forces out via an outlet in the diaphragm. It is the muscle that separates the chest and abdomen. Small hernias would not generate any manifestations and can recover on their own. However, a few cases of Hiatal hernias induce indications identical to those of gastroesophageal reflux diseases, like heartburn and reflux of acids. In these cases, fundoplication is recommended for the management of hernia.
How Is Pre-evaluation Done for Gastric Fundoplication?
Fundoplication is a final treatment option or surgery for gastroesophageal reflux disease or a Hiatal hernia. It occurs when the stomach forces up through the diaphragm.
In these cases, the doctor will recommend surgery following the failure of all other procedures to control the symptoms, such as-
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Weight loss in obese patients.
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Avoid certain foods which will worsen the symptoms, such as alcohol.
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Medications for conditions that induce gastroesophageal reflux disease include insulin for diabetes.
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They also do not suggest this procedure if it does not resolve symptoms. Like mild gastroparesis, a situation in which the stomach empties gradually, fundoplication benefits in these cases. But fundoplication would not bring better outcomes in the treatment of extreme gastroparesis.
What Are the Types of Gastric Fundoplication?
Different types of gastric fundoplication include-
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Nissen 360-Degree Wrap- In this procedure, the fundus is covered entirely near the lower end of the esophagus to constrict the sphincter. In addition, it reduces vomiting because it may aggravate gastroesophageal reflux disease.
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Toupet 270-Degree Posterior Wrap- In this procedure, the fundus is covered two-thirds of the back side, or this is done on the back portion of the esophagus end. It creates a valve that easily supports gas removal via vomit if needed.
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Watson Anterior 180-Degree Wrap- In this procedure, the portion of the esophagus adjacent to the diaphragm is rebuilt. Then, the fundus is wrapped midway around the front region lower area of the esophagus and connected to the portion of the diaphragm. This procedure is accomplished laparoscopically.
How Is The Procedure of Gastric Fundoplication Done?
In the initial state, the doctor will keep intravenous tubes in the veins. So it is done for the fluid ordinance and anesthesia during the procedure. Each procedure endures an average of four hours.
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Some tiny incisions are created via the skin and the peritoneum, a tissue layer near the gut.
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A delicate tube with a light, camera, and small tools is placed into the cuts.
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The lower esophagus tissue surrounds the fundus.
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Absorbable sutures are utilized to connect the fundus to the food pipe.
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Gas present in the stomach is removed, and surgical devices are extracted from the surgical site.
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The incisions are sealed with absorbable sutures.
What Are the Complications of Gastric Fundoplication?
There are certain complications of gastric fundoplications, it includes-
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Tearing the walls in the esophagus, stomach, or lung tissues surrounding the site is more common in laparoscopic approaches.
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Surgical site infection.
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Break down of sutures and reveal the surgical site.
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Infections in the lungs, such as pneumonia, thus having difficulty in swallowing.
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Dumping syndrome, during the passage of food, happens quickly from the stomach to the intestines.
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Common symptoms like nausea and gagging.
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Gas formation in the stomach.
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Continuous reflux.
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In some cases, there is a need for follow-up surgery.
Conclusion:
Fundoplication is the definitive surgical treatment for gastroesophageal reflux disease in cases with no improvement following conservative therapy approaches. These include drug therapy and lifestyle modification. A Nissen fundoplication is a procedure that is well accepted and done to correct gastroesophageal reflux disease.
The process compresses the connection between the food pipe and the abdomen to control acid reflux. The laparoscopic procedure is more acceptable as it is less invasive and has a quicker recovery than open surgical procedures. Thus, surgical management is not a substitute for other treatment methods. Initially, surgeons will recommend nonsurgical management if it is not functioning correctly. Therefore surgical management is done.
