Fundoplication

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.

  1. Nissen 360° posterior fundoplication.
  2. Toupet 270° posterior fundoplication.
  3. Dor 180-200° anterior fundoplication.
  4. 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
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Article information

rID: 35706
Section: Approach
Tags: refs, cases
Synonyms or Alternate Spellings:
  • Fundoplication types
  • Fundoplications

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