Fundoplication - ANH00011
MEDICAL ANIMATION TRANSCRIPT: Your surgeon may perform a fundoplication to treat gastroesophageal reflux disease, or to repair a hiatal hernia. Digestion begins in the mouth. As teeth break food into smaller pieces, saliva releases digestive enzymes. When food is swallowed it enters the esophagus, a long muscular tube that carries food from the mouth to the stomach for further digestion. Contractions called peristalsis push food down the esophagus. At the bottom of the esophagus, food passes through a muscular valve called the lower esophageal sphincter, or LES, and into the stomach. The digestive juices secreted by the stomach are highly acidic. When the stomach contracts to move the food into the intestine, the LES closes tightly in order to prevent these acidic juices from moving back into the esophagus, where it can cause damage. A breathing muscle called the diaphragm separates the chest from the abdomen. To reach the stomach, the esophagus passes through the diaphragm at a point called the hiatal ring. If you have gastroesophageal reflux disease, or GERD, your LES does not close properly, allowing acidic stomach contents to flow backward into your esophagus. If GERD is not treated, it can lead to a variety of esophageal problems, including: ulcers; bleeding; strictures or narrowings; and Barrett's esophagus, which is the abnormal growth of intestinal-type cells in the esophagus that can lead to cancer. If you have a hiatal hernia, a portion of your stomach is protruding into your chest cavity through the opening in your diaphragm. A hiatal hernia can affect the LES, and increase the risk and severity of GERD. To begin your procedure, an IV line will be inserted into your arm to provide fluids and medication. A catheter may be placed into your bladder to drain urine. You'll be given general anesthesia, which will put you to sleep for the entire procedure. Once you are asleep, a breathing tube will be inserted through your mouth and into your windpipe to help you breathe during the operation. One of two methods may be used for a fundoplication. In the traditional open procedure, your surgeon will begin by making an eight inch incision in the abdomen to expose the stomach and lower esophagus. After separating it from nearby structures, your surgeon will wrap the fundus, or upper part of the stomach, around the lower esophagus and stitch it into place. This wrap acts as a belts which tightens and strengthens the LES. the laparoscopic procedure, your surgeon will begin by making five small keyhole incisions, each about one half inch long, in your abdomen. Through one incision, your surgeon will insert the laparoscope, which is a long, thin tube equipped with a light and a camera. The camera sends images to a video screen for the surgeon to view. Gas will be pumped in to inflate your abdomen to enable the surgeon to see your internal organs more clearly. Through the other incisions, your surgeon will use instruments to detach the fundus of your stomach from its surroundings, wrap it around your lower esophagus, and stitch it into place. If you have a hiatal hernia, your surgeon will pull the herneated part of the stomach back into place in the abdomen, and tighten the hiatal ring in the diaphragm to prevent another hernea. This can be done through either an open or laparoscopic procedure. To complete the surgery, the abdominal incisions are closed with stitches or staples. When you awake from surgery, you will find a small tube passing through your nose and into your stomach. This tube helps remove fluids and gas from the site of the surgery, and is usually removed within two days. You will be encouraged to get out of bed and begin walking the same day of surgery.