Last revised by Kieran Kusel on 1 Apr 2022

Fundoplications are forms of antireflux surgery used as a second line of treatment of gastroesophageal reflux disease after failure of medical treatment and the first line of treatment of paraesophageal hernia.

A gastric fold is wrapped around the distal esophagus which enforces the lower esophageal sphincter and prevents gastroesophageal reflux. Additionally, narrowing the esophageal diaphragmatic hiatus will help to maintain the fundoplication reinforced lower esophageal sphincter in the abdomen 3.

  • Nissen 360° posterior fundoplication
  • Toupet 270° posterior fundoplication
  • Dor 180-200° anterior fundoplication
  • Thal 270° anterior fundoplication

An upper GI contrast study 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 located below the diaphragm. It should measure no more than 2 cm in length. There should be proper esophageal emptying and no gastric reflux.

  • tight fundoplication: manifests as dysphagia and achalasia-like symptoms and occurs when the fundoplication is tight and long (>2 cm)
  • slippage: the fundoplication surrounds the stomach with retraction of the gastroesophageal junction into the chest; it manifests as recurrent gastroesophageal reflux
  • disruption: the most common complication and occurs when the fundal sutures slip; it manifests as recurrence of reflux symptoms
  • twisted fundoplication and gastric volvulus: rare and urgent complication

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