Definition of Fundoplication

Fundoplication: a surgical technique that strengthens the barrier to acid reflux when the lower esophageal sphincter does not work normally and there is gastroesophageal reflux (stomach acid that goes back up into the esophagus).

Fundoplication has been the standard surgical method for treating gastroesophageal reflux disease (GERD). GERD is the constellation of inflammation, pain (heartburn), and complications that result when acid refluxes (regurgitates) from the stomach back up into the esophagus. Under normal conditions, there is a barrier to acid reflux. One part of this barrier is the lower-most muscle of the esophagus (called the lower esophageal sphincter), which usually contracts and closes off the esophagus from the stomach. In people with GERD, the esophageal sphincter does not work normally. The sphincter is weak or relaxes inappropriately, allowing acid from the stomach to go back up into the esophagus.

During the fundoplication procedure, the part of the stomach that is closest to the entry of the esophagus (the fundus of the stomach) is gathered, wrapped, and sutured (sewn) around the lower end of the esophagus and the lower esophageal sphincter. (The gathering and suturing of one tissue to another is called plication.) Fundoplication increases the pressure at the lower end of the esophagus, and thereby reduces acid reflux. A total fundoplication wraps the fundus completely around the esophagus and is known as a Nissen fundoplication. Other types of fundoplication procedures wrap different parts of the fundus around the esophagus and include Thal, Belsey, Dor, Lind, and Toupet fundoplications.

Also, during fundoplication, other surgical steps frequently are taken that also may reduce acid reflux. For example, if the patient has a hiatal hernia (which occurs in 80% of patients with GERD), the hernial sac may be pulled down from the chest and sutured so that it remains within the abdomen. Additionally, the opening in the diaphragm through which the esophagus passes from the chest into the abdomen may also be tightened. Fundoplication may be done using a large incision (laparotomy or thoracotomy) or a laparoscope, which requires only several small punctures in the abdomen. The advantage of the laparoscopic fundoplication procedure is that there is less post-operative pain, and the recovery time is faster.

The term fundoplication is composed of fundo-, referring to the fundus (the upper portion) of the stomach + -plication, an operation for reducing the size of a hollow organ (in this case, the stomach) by taking folds or tucks in its walls.