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Laparoscopic fundoplication +/- hiatus hernia repair involves dissecting the junction between the swallowing pipe and the stomach, as it enters the abdomen. Any associated hiatus hernia (abnormal protrusion of the top of the stomach into the chest) is repaired. The upper part of the stomach (‘fundus’, hence ‘fundoplication’) is then partially wrapped around the lower part of the swallowing pipe (‘oesophagus’) in the abdomen. This reinforces the natural valve that stops acid reflux.
Severe reflux symptoms:
- no longer controlled by medication (PPI’s).
- with major quality of life disruption (e.g. poor sleep).
- hiatus hernia with prominent regurgitation symptoms.
The snugness of the hiatus hernia repair and fundoplication is calibrated / sized by having a rubber tube (‘bougie’) in the swallowing pipe during surgery. Despite this, because of post-operative swelling of the food pipe, most patients will have mild difficulty swallowing food for the first 4 - 6 weeks after surgery. Patients are advised to consume 1 week each of liquids, pureed then soft foods after surgery to minimise this problem. Longer term, some patients may experience very mild heartburn or swallowing difficulty, much less than anything they would have had before surgery.
Reflux and Heartburn