Fundoplication can involve a complete (360 degree) or partial (varying degrees) wrap of the lower esophageal sphincter (LES). Variations may occur during surgery, including differences in the tightness, completeness or length of the wrap. The most common variants of fundoplication are:
This is the most commonly performed fundoplication. It involves wrapping a portion of the stomach completely (360 degrees) around the base of the esophagus, significantly increasing LES muscle pressure. Postoperative symptoms, such as gas and bloating (gas/bloat syndrome), occur more frequently with this type of fundoplication. This operation is recommended for patients with normal esophageal length and no existing motility problems within the esophagus. (see video of laparoscopic Nissen fundoplication)
Toupet fundoplication involves a partial wrapping (usually 180 to 200 degrees) around the LES. This partial wrap appears to control reflux as well a Nissen wrap, but with fewer postoperative symptoms (such as gas/bloat syndrome)). It is recommended for patients with normal esophageal length and decreased motility within the esophagus.
This partial wrap involves reinforcing 270 degrees of the circumference of the LES. This procedure is performed through the chest rather than the abdomen. It is recommended for obese patients, patients with a shorter-than-normal esophagus and patients with decreased motility within the esophagus.
A modified version of open or laparoscopic fundoplication, known as endoluminal fundoplication (ELF), accesses the stomach though the mouth, which eliminates the need for incisions. This technique is currently being practiced in Europe, but has not been approved by the U.S. Food and Drug Administration.
There is no one operation that works best for all patients. Factors that may play a role in determining a fundoplication type include previous surgeries, problems with the movement of food within the esophagus, length of the patient’s esophagus, patient’s body weight and available surgical expertise.
GERD Surgery- Fundoplication Variations - References
By Mortin - Copyright 2010
Last modification 05/02/2010