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Definition of «Fundoplication»


Fundoplication (anti-reflux surgery): A surgical technique that strengthens the barrier to acid reflux when the lower esophageal sphincter does not work normally and there is gastro-esophageal reflux.

Fundoplication has been the standard surgical method for treating gastro-esophageal reflux disease (GERD). GERD is the constellation of inflammation, pain (heartburn), and complications that results 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 is contracted and closes off the esophagus from the stomach most of the time. In people with GERD, the sphincter does not work normally. It is weak or relaxes inappropriately, permitting the 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.) This procedure increases the pressure at the lower end of the esophagus and thereby reduces acid reflux.

Also, during fundoplication, other surgical steps are frequently taken that also may reduce acid reflux. For instance, 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 method is a speedier recovery and less post-operative pain.

Although fundoplication is the standard method for treating GERD, it presently is being challenged by endoscopic methods. Endoscopy utilizes endoscopes, which are long flexible tubes that are swallowed by patients. The inside of the esophagus can be viewed through the endoscope and various instruments can be passed through channels in the endoscope. In one endoscopic method for treating GERD, an instrument is inserted that delivers an electrical current to the lower esophageal sphincter. This results in scarring, which tightens the sphincter. In another method, sutures are placed in the sphincter to tighten the sphincter. Both methods reduce acid reflux.

Endoscopic methods offer a simpler way of treating GERD than fundoplication. However, it is too early to say how effective, safe, or long-lasting the endoscopic methods will be.

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.

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