Fundoplication for GERD: Procedure Types, Outcomes & Recovery

Fundoplication: Surgical Treatment for Refractory GERD

Fundoplication reinforces the lower esophageal sphincter (LES) by wrapping the gastric fundus around the distal esophagus, creating a valve-like barrier against reflux.

Procedure

• Typically laparoscopic (5 small ports); 1–2 hours under general anesthesia.
• Fundus mobilized, wrapped 360° (Nissen), 270° posterior (Toupet), or anterior (Dor) around esophagus.
• Sutured in place; hiatal hernia repaired concurrently if present.

Variations

• Nissen (360°): Gold standard; best reflux control but higher dysphagia/gas-bloat risk.
• Toupet (270° posterior): Partial wrap; less dysphagia; preferred for weak peristalsis.
• Dor (anterior 180–200°): Often combined with myotomy for achalasia.

Outcomes

• 85–95% symptom resolution at 5–10 years.
• Most off PPIs long-term.
• Recurrence ~10–15% at 10 years (wrap disruption, hernia recurrence).

Post-Op

Liquid → pureed → soft diet over 2–4 weeks. Avoid carbonation, large meals, lying flat post-prandial. Follow surgeon's protocol.