Laparoscopic fundoplication with or without hiatal hernia repair is an operation which is performed to improve symptoms of reflux. It involves operating around the junction of the oesophagus (food pipe) and upper stomach to improve the function of the lower oesophagus sphincter (valve). If a hiatal hernia (protrusion of stomach into the chest) is present it will be reduced into the abdomen. A fundoplication involves wrapping the fundus (part of the stomach) around the oesophagus to help prevent reflux.
- Treatment of reflux or regurgitation
- Presence of hiatal hernia
- Evidence of bleeding or dysphagia secondary to hiatal hernia
Fundoplication and hiatal hernia repair are typically performed laparoscopically. Surgery involves dissection of the oesophageal hiatus (where the oesophagus passes through the diaphragm). Occasionally a hiatal hernia will be present and need to be repaired at the time of surgery. The oesophagus is mobilised to allow 4-5cm of abdominal oesophagus. The stomach is then wrapped around the oesophagus (fundoplication). A fundoplication can be performed in 3 ways:
- Anterior (Dor) 180 degree wrap
- Posterior (Toupet) 270 degree wrap
- 360 degree (Nissen) wrap