Fundoplications are forms of antireflux surgery used as a second line of treatment of gastroesophageal reflux disease after failure of medical treatment and first line of treatment of paraesophageal hernia.
A gastric fold is wrapped around the distal esophagus which enforces the lower esophageal sphincter and prevent gastroesophageal reflux.
- Nissen 360° posterior fundoplication.
- Toupet 270° posterior fundoplication.
- Dor 180-200° anterior fundoplication.
- Thal 270° anterior fundoplication.
Barium study of the upper GI is the main imaging technique for evaluation of postoperative fundoplication and its complications.
Fundoplication appears as a gastric fundal defect that surrounds the distal esophagus, locates below the diaphragm and no more than 2 cm in length. There should be proper esophageal emptying and no gastric reflux.
- tight fundoplication: manifested as dysphagia and achalasia like symptoms and occurred when the fundoplication is tight and long (>2 cm)
- slippage: the fundoplication surrounds the stomach with retraction of the gastroesophageal junction to the chest; it is manifested as recurrent gastroesophageal reflux
- disruption: the most common complications and occurred when the fundal sutures slipped; it is manifested by recurrence of reflux symptoms
- twisted fundoplication and gastric volvulus: rare and urgent complication
- 1. Baker ME, Einstein DM, Herts BR et-al. Gastroesophageal reflux disease: integrating the barium esophagram before and after antireflux surgery. Radiology. 2007;243 (2): 329-39. doi:10.1148/radiol.2432050057 - Pubmed citation
- 2. Graziano K, Teitelbaum DH, McLean K, Hirschl RB, Coran AG, Geiger JD. Recurrence after laparoscopic and open Nissen fundoplication: a comparison of the mechanisms of failure. Surg Endosc. 2003 May;17(5):704-7. 2. Kimber C, Kiely EM, Spitz L. The failure rate of surgery for gastro-oesophageal reflux.