Procedure Overview

The surgery is performed under general anesthesia and typically takes about 30 minutes, or up to an hour for repairs on both sides.
Local anesthesia may be used postoperatively to manage pain.
Antibiotics may be given during surgery to reduce infection risks.

Surgical Process

The surgeon uses laparoscopic (keyhole) surgery, which results in less pain, less scarring, and a quicker recovery compared to open surgery.
A small incision near the belly button is made to insert an instrument that inflates the abdominal cavity with carbon dioxide gas for better visibility.
Two small cuts are made to insert surgical instruments through tubes (ports).
The surgeon repairs the hernia by returning the protruding tissue to its correct place and reinforcing the weak spot with synthetic mesh.
The incisions are then closed using stitches or glue.

Possible Conversion to Open Surgery:

In about 1 in 100 cases, laparoscopic surgery cannot be completed, and the procedure may need to be converted to:
Transabdominal laparoscopic surgery, where instruments are inserted into the abdominal cavity.
Open surgery, which requires a larger incision in the groin.

Final Steps:
Once the hernia is repaired, the surgical instruments are removed, and the incisions are closed.

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).

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.

3. Short Term Complications:

Pneumothorax : Air escapes into the space around the lungs, sometimes requiring a chest drain.
Perforation : A hole in the oesophagus or stomach (risk: 1 in 100) may require surgical repair and a longer hospital stay.
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.
Liver Damage : Moving the liver during surgery can cause injury (risk: 5 in 100), sometimes needing another operation.
Spleen Damage : In rare cases, the spleen may need to be removed.
Difficulty Swallowing : Temporary inflammation from the surgery may cause swallowing issues for a few months but typically resolves within three months.

4. Long Term Complications:

Persistent Swallowing Difficulty : Some patients (risk: 5 in 100) may struggle to swallow certain foods like bread and meat.
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).
Weight Loss : Feeling fuller than usual may cause temporary weight loss. Small, frequent meals can help maintain weight.
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.
Diarrhoea : A small number of patients (risk: less than 3 in 100) may experience loose stools, which can be managed with medication.
Adhesions (Scar Tissue Formation) – Tissues may stick together abnormally, potentially causing bowel obstruction, though the risk is lower with keyhole surgery.
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.

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.

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.