Center for Minimally Invasive Esophageal Therapies
The Center for Minimally Invasive Esophogeal Therapies at Boston Medical Center is dedicated to serving you and your family by providing you with the most advanced and effective medical treatment in New England for gastroesophageal reflux disease, or GERD, as well as unmatched patient care. Our staff of compassionate diagnosticians, surgeons, physician assistants, nurse practitioners and surgical nurses collaborate to treat you in our state-of-the-art facilities and help guide you on the path to recovery in the most comfortable way possible.
Fundoplication is a surgical treatment for gastroesophageal reflux disease, or GERD. In GERD, your lower esophageal sphincter (LES)—the ring of muscle that connects your esophagus and your stomach—relaxes between swallows, allowing stomach acid to flow back into your esophagus.
Unlike your stomach, the esophagus does not produce mucous to protect it against acid corrosion, which results in irritation in the esophageal lining when reflux occurs. In many cases, patients with reflux also have hiatal hernias where part of the stomach has slipped into the chest cavity rather than remaining in the abdomen.
There are a variety of ways to treat GERD, such as lifestyle modifications and medication, but if these methods are not successful, your physician may suggest fundoplication. Your surgeon will wrap the upper curve of your stomach (the fundus) around the LES, strengthening it and lessening GERD symptoms.
Your physician will recommend one of the following types of fundoplication, according to your situation. The type of fundoplication depends on several factors such as the severity of your GERD, the presence of a hiatal hernia and its size, and whether or not you have had previous operations in this area.
- Laparoscopic fundoplication. In this minimally invasive version of fundoplication, which requires general anesthesia, your surgeon will make four or five small incisions in your abdomen and then insert a thin, lighted tube called a laparoscope, along with surgical instruments. Laparoscopic fundoplication reduces scarring, pain and recovery time associated with more invasive methods.
- Endoscopic fundoplication. This procedure is performed under general anesthesia using an endoscope (a long, thin tube that is placed through your mouth and into your esophagus). This approach does not require incisions. However, this is only suitable for patients who have no—or very small—hiatal hernias.
- Transabdominal. Your surgeon will make a standard surgical incision in your abdomen to access your stomach and esophagus and perform the fundoplication.
- Transthoracic. Your surgeon will make a standard surgical incision in your chest wall to access your stomach and esophagus and perform the fundoplication.
How to Prepare
It is important to follow any instructions given to you by your physician. These instructions generally include not eating or drinking anything after midnight on the night before your procedure, bringing a list of your medications with you to the hospital and arriving one hour before your surgery.
You may have a pre-admission appointment weeks beforehand, during which you will have routine blood tests and meet with the anesthesiologist, who will administer medicine during your procedure that puts you to sleep and eases pain.
Try to stay healthy by being active, eating a balanced diet, and limiting tobacco and alcohol consumption leading up to your scheduled surgery. Make a list of all medications you take and bring it with you. Include prescription and over-the-counter medications, herbs, supplements, aspirin and corticosteroids.
What to Expect
One day before your procedure, you should receive a call from us. You will be given information about the day of your procedure, including where to go and when to arrive.
When you arrive, you will be taken to a pre-surgery area so that we can take your temperature, blood pressure, pulse, and listen to your heart and lungs. We will place an intravenous (IV) line in a vein in your arm, so that medications and fluids may be administered before, during and after the procedure.
After you are given anesthesia, your surgeon will make the necessary incision(s), or insert the endoscope. Once he or she has access to the the lower esophageal sphincter (LES), the part of the upper stomach closest to the esophagus is gathered, wrapped and sewn around the lower end of the esophagus and the LES. This part of the procedure, called plication, increases pressure and strengthens the LES so that acid cannot flow backward as easily. When your surgeon has completed the fundoplication, any instruments are removed and your incisions are closed.
After surgery, you will be taken to the Post Anesthesia Unit and monitored for any changes in blood pressure, heart rate and breathing. An IV line will remain in a vein in your arm to keep you hydrated and administer pain medication, if necessary. If a breathing tube was inserted during surgery to control your breathing, it may remain in place for a brief time.
If you had laparoscopic surgery, you will likely remain in the hospital for one to two days, and full recovery may take two to three weeks, as opposed to open surgery, which can take up to six weeks. You will be on a modified diet for a time after surgery and will receive instructions from the dietitian in the hospital before you leave. It is important to follow your doctor's istructions regarding post-procedure eating, drinking and medications. Call us if you have any questions or changes.