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At the location where the esophagus (food pipe) meets the stomach, a valve called the Lower Esophageal Sphincter (LES) Valve keeps the food from escaping from the stomach, into the esophagus. When the LES valve becomes weak, contents of the stomach can escape back into the esophagus.
This flow back, called reflux, is acidic in nature and it can burn the esophagus. Prolonged acid reflux can result in esophageal cancer.
Understanding Laparoscopic Fundoplication
Weak LES Valve, that causes acid reflux, is a mechanical failure. Hence, it needs a surgical correction.
In order to correct the weak LES valve, the surgeon takes the upper part of the stomach and wraps is around the lower part of the esophagus. After this surgery, whenever the stomach contracts, it shuts down the valve. So, instead of the food flowing back in to the esophagus, it remains in the stomach.
How is Lap Fundoplication Performed
Here are the steps involved in a typical fundo procedure:
One to five tiny slits are made in the abdomen to access the inside
Mobilizing the Esophagus
Bottom most 5cm to 8cm of esophagus is set free from the stuructures it is attached to. This increasead length of food pipe is important as it prevents future reflux
Tightening the Diaphragm
The muscular sling around the the diaphragm is tightened around the esophagus and tighten it with a series of sutures, or in some cases, a mesh.
Separating the Stomach
The upper most part of the stomach called the fundus is made free by separating it from the spleen
Plicating the Fundus
The freed fundus is taken behind the gullet, wrapped around the lower esophageal sphincter and sutured (or plicated) on to itself.
Because the fundus is plicated or stitched around the lower esophageal sphincter, this procedure is called the fundoplication.
Esophageal cancer is the fastest growing cancer in many parts of the world, including the USA, China and India. Untreated GERD and LPR are believed to be the largest contributors to growth of esophageal cancer.
Laparoscopic Fundoplication FAQ’s
If in the early stages of severe reflux disease, before you develop a Barrett’s esophagus, the fundoplication will certainly prevent a cancer. If on the other hand you are unfortunate enough and you have already developed what is known as a Barrett’s esophagus, then even performing the fundoplication, although it will reduce the chances, might not reduce the risk, might not completely bring down to zero the risk of a cancer developing in your esophagus. The message is the same. Please sort it out before becomes it’s too late
Yes, almost certainly, for the first two to three weeks you will have difficulty in swallowing. As the time goes by, you will be able to eat and drink practically normally without any problem at all. This is because your body is in the process of getting used to the new valve that is created in the process of a fundoplication.
No, almost all fundopllications are done in experienced units, laparoscopically only. In the last 2000 ++ Laparoscopic fundopllications, we have not had to convert even one into an open surgery.
No, there are no other side effects. And personally I feel this is a grossly under used procedure considering the number of people who are suffering with reflux and acid heartburn.
No, you should have a 24 hours pH study and demonstrate to yourself, your family and your physician, that you have severe enough reflux to warrant a procedure. Otherwise, if you can manage with proton pump inhibiter etc, you don’t really need a surgery, if your 24 hours pH study does not show severe reflux.
Laparoscopic Fundoplication Surgeons
Dr. J. S. Rajkumar
M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)
Dr. Anirudh Rajkumar
Bariatric and Laparoscopic Surgeon
M.B.B.S., Dip.N.B. (GENERAL SURGERY).