Laparoscopic Hiatus Hernia Repair / Fundoplication

Fundoplication Procedure Overview

1. Pre-Surgery Checks:
The healthcare team ensures the patient is ready for surgery by checking for allergies and confirming the procedure details.


2. Anesthesia and Duration:

  • The operation is performed under general anesthesia and usually takes 1-2 hours.
  • Local anesthetic may be used to manage post-surgery discomfort.
  • Antibiotics may be given to reduce the risk of infection.

     

3. Surgical Steps:

  • The surgeon moves the liver aside and frees up the upper stomach and lower oesophagus.
  • If a large gap exists in the diaphragm, it is stitched to reduce the size and prevent future hiatus hernias.
  • The top part of the stomach is wrapped and stitched around the lower oesophagus to reinforce the valve and prevent acid reflux.
  • The stomach can be wrapped fully or partially, depending on the patient’s condition.

4. Laparoscopic (Keyhole) Surgery:

  • Small incisions are made near the belly button for inserting surgical instruments.
  • The abdominal cavity is inflated with carbon dioxide gas to improve visibility.
  • This method results in less pain, smaller scars, and a quicker recovery compared to open surgery.

5. Possible Open Surgery Conversion:

In rare cases (less than 2 in 100), keyhole surgery may not be feasible, requiring a switch to open surgery, which involves a larger incision and longer recovery.
The fundoplication procedure helps improve acid reflux symptoms and prevent future complications like oesophagitis and hernias.

How can I prepare for surgery?

1. Lifestyle Changes:

  • Stop smoking to reduce the risk of complications and improve long-term health.
  • Maintain a healthy weight, as being overweight increases the risk of complications. If you are significantly overweight your surgeon may recommend a special diet for two weeks before the procedure to reduce liver size, making surgery safer.
  • Regular exercise can help with preparation and recovery.

2. Reducing Infection Risk:

  • One week before surgery: Avoid shaving or waxing the area where a cut may be made.
  • Bathing: Take a bath or shower the day before or on the day of the procedure.
  • Keep warm: Inform healthcare staff if you feel cold before the procedure.
  • Diabetic patients: Maintain blood sugar levels around the time of surgery.

Following these steps can help ensure a smoother procedure and recovery.

 

What are the potential risks or complications of the procedure?

1. General Surgical Complications:

  • Bleeding during or after the procedure, rarely requiring a blood transfusion.
  • Hernia formation at the surgical site, which may require further surgery.
  • Infection at the wound site, treatable with antibiotics but sometimes requiring special dressings.
  • Venous thromboembolism (VTE) – Blood clots in the leg (DVT) or lungs (pulmonary embolism), which can be serious.
  • Chest infections, particularly in smokers or those recovering from COVID-19.
  • Adhesions (scar tissue) leading to bowel obstruction, possibly requiring another procedure.
  • Allergic reactions to medications, materials, or dyes (rare but possible).
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2. Keyhole Surgery Complications:

  • Damage to internal structures (e.g., bowel, liver, blood vessels), which may require open surgery (risk: < 3 in 1,000).
  • Surgical emphysema (trapped gas in the skin) or gas embolism (rare but serious).
  • Conversion to open surgery if keyhole surgery is not possible.
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3. Short Term Complications:

  1. Pneumothorax : Air escapes into the space around the lungs, sometimes requiring a chest drain.
  2. Perforation : A hole in the oesophagus or stomach (risk: 1 in 100) may require surgical repair and a longer hospital stay.
  3. Stitch Tear : If you vomit or strain in the first few weeks, the wrap may loosen, or a stomach hole may develop, requiring immediate surgery.
  4. Liver Damage : Moving the liver during surgery can cause injury (risk: 5 in 100), sometimes needing another operation.
  5. Spleen Damage : In rare cases, the spleen may need to be removed.
  6. Difficulty Swallowing : Temporary inflammation from the surgery may cause swallowing issues for a few months but typically resolves within three months.
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4. Long Term Complications:

  1. Persistent Swallowing Difficulty : Some patients (risk: 5 in 100) may struggle to swallow certain foods like bread and meat.
  2. Incomplete Reflux Control : If the wrap loosens or is too loose, symptoms may persist but can often be managed with medication (risk: less than 5 in 100).
  3. Weight Loss : Feeling fuller than usual may cause temporary weight loss. Small, frequent meals can help maintain weight.
  4. Abdominal Discomfort and Bloating : Up to 3-5 in 10 people may experience gas buildup due to an inability to burp, leading to bloating and increased flatulence.
  5. Diarrhoea : A small number of patients (risk: less than 3 in 100) may experience loose stools, which can be managed with medication.
  6. Adhesions (Scar Tissue Formation) – Tissues may stick together abnormally, potentially causing bowel obstruction, though the risk is lower with keyhole surgery.
  7. Need for Additional Surgery – If severe symptoms persist beyond three months, another operation may be required (risk: less than 5 in 100).

While fundoplication is effective in treating reflux, some risks and long-term adjustments should be considered before undergoing the procedure.

Recovery After Surgery

1. Hospital Recovery:

  • After the operation, patients are transferred to the recovery area and then to a ward.
  • Anti-sickness medication is given.
  • Drinking is allowed on the first day, followed by a soft diet.
  • Acid-reducing medication is usually no longer needed.
  • Most patients can go home the same day or the next, but some may need to stay longer based on their condition.

    Warning Signs of Complications:

    Patients should watch for serious symptoms, including:

  • Worsening pain with movement, breathing, or coughing.
  • Fever or high temperature.
  • Dizziness, fainting, or shortness of breath.
  • Loss of appetite or worsening nausea after the first 1-2 days.
  • Inability to pass stools or wind.
  • Abdominal swelling.
  • Difficulty urinating.

    If any of these symptoms occur, immediate medical attention is required.

2. Returning to Normal Activities:

  • Follow dietary instructions carefully to reduce the risk of complications. Start with a liquid diet, then transition to soft foods.
  • Eat slowly and chew thoroughly.
  • Avoid heavy lifting and manual work for a few weeks.
  • Exercise is encouraged but should be resumed only with medical approval.
  • Avoid driving until you can control your vehicle safely and check insurance requirements.
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3. Long-Term Recovery:

  • A full recovery is expected, with reflux symptoms significantly reduced or eliminated.
  • A normal diet can usually be resumed after six weeks, but fizzy drinks should be avoided.
  • Most patients return to work within a few weeks, depending on job type and individual recovery.

With proper care and adherence to medical advice, fundoplication provides lasting relief from acid reflux symptoms.

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