Laparoscopic fundoplication

Gastroesophageal reflux disease and hiatal hernias are among the most pressing issues in modern gastroenterology. These conditions are most commonly diagnosed in men and women over the age of 50. Reflux disease is an inflammation of the stomach lining caused by the backflow of stomach acid into the esophagus. A hernia may appear at the esophageal opening. Gastroesophageal reflux disease can be treated both conservatively and surgically, with laparoscopic fundoplication most commonly used for surgery. Laparoscopic fundoplication is a procedure to correct reflux, where part of the stomach is wrapped around the esophageal opening to create a cuff. This operation restores the anatomical integrity and function of the organ.

Laparoscopic fundoplication is a minimally invasive surgical procedure performed through small incisions in the abdominal cavity. The minimal invasiveness of the operation allows the patient to avoid a lengthy rehabilitation period and enables a quick recovery.

 Laparoscopic fundoplication is carried out in the thoracoabdominal department by professional surgeons with extensive experience in treating digestive system disorders and various hernias in the abdominal area. The aim of the operation is to create pressure in the lower stomach sphincter, which prevents the development of reflux.

The success of an operation depends on the surgeon’s professionalism, ensuring that no undesirable consequences occur. Among the complications following surgical procedures, the most common is a disruption of the swallowing reflex, or dysphagia. A side effect of fundoplication may also be an inability to burp or vomit.

Laparoscopic fundoplication can create a barrier to the backward movement of stomach contents. This consequence adversely affects the patient’s condition, causing discomfort in the abdominal area, bloating and pain. Constant heartburn and belching are among the symptoms of reflux, often occurring during severe coughing, bending forward, after eating, or when lying down.

With insufficient treatment of this condition, there is a risk of developing a stomach ulcer or cancer.

Laparoscopy is used when medication alone is insufficient, to prevent possible recurrence of the disease, and to achieve rapid recovery.

Laparoscopic fundoplication involves relieving symptoms caused by the reflux of stomach acid onto the stomach lining.

Indications for the procedure include:

• inflammation in the stomach;
• gastroesophageal reflux disease;
• changes in the epithelial cells of the stomach.

Contraindications for the procedure include:

• severe diabetes mellitus;
• elderly age;
• liver and kidney diseases;
• mental illnesses.

Laparoscopic fundoplication surgery is performed for patients who are not at risk of serious complications. The surgical plan is based on diagnostic indications, specifically following radiological examination of the upper abdomen, esophagogastroduodenoscopy, and laboratory blood tests. Patients are also prescribed 24-hour pH monitoring.

The procedure involves treating reflux and performing cruroplasty if repair of the esophageal hiatus is necessary. When a hernia is detected, the surgeon assesses the large distance between the edges of the diaphragm, which must be stitched together. Performing cruroplasty is essential to prevent disease recurrence. A specialized mesh material is used for the repair to close the defect. If the space cannot be sutured, closure is achieved using the stomach wall. After cruroplasty, the surgeon proceeds with creating the fundic wrap.

Before performing fundoplication and cruroplasty, the patient undergoes general anesthesia. After preparing the patient and inducing medical sleep, 4–5 special punctures are made in the abdominal cavity. Special instruments are inserted through these punctures. During laparoscopic surgery, an enlarged image is displayed on a monitor for optimal control. Cruroplasty and creation of the gastric wrap are performed. The instruments are removed and sutures are applied.

The rehabilitation period during the first day focuses on careful monitoring of the patient under medical supervision. Pain relief therapy and daily wound care are prescribed by the doctor. A specialized diet is recommended to alleviate any potential discomfort.

• The risk of developing complications during surgery is virtually eliminated.
• Minimally invasive and painless in the postoperative period.
• Recovery lasts about 3 weeks, after which the patient returns to their usual lifestyle.
• Long-lasting effect, no need to follow a strict diet or take medications afterwards.
• The likelihood of recurrence within the first year after surgery does not exceed 2%.