Preoperative tests such as a blood test, urinalysis, and possibly an EKG may be performed a few days before the scheduled surgery, depending on the patient's health.
Some medications must be discontinued prior to the operation, such as drugs that "thin" the blood (e.g., Coumadin®, aspirin), and others must be withheld the day of surgery. This must be discussed with the physician as soon as the decision to operate is made.
Since the fundoplication is performed under general anesthesia, no food or liquid (including water and hard candy) may be consumed after midnight the night before surgery. This restriction reduces the risk of vomiting during or immediately after surgery.
Patients usually check in to the hospital the day before or the day of surgery. Patients must sign an informed consent form, which states that the procedure has been explained to them, they are aware of the risks, and that they know they will be receiving general anesthesia and possibly other medications.
The doctor who administers the anesthesia (i.e., anesthesiologist) speaks to the patient prior to surgery and performs a brief physical assessment. The anesthesiologist must be aware of all medications that are being taken, any allergies, and any prior adverse reaction to anesthesia. This information helps the anesthesiologist select the most suitable anesthetic agents and dosages and avoid possible complications.
The patient is then taken to the preoperative or holding area and must remain in bed, except to use the bathroom. An intravenous is started for fluids and medication, if the patient does not already have one. Sedation is given through the intravenous or by injection to induce drowsiness. Anesthesia is administered in the operating room.
Postoperative CareAfter surgery, the patient is taken to the postanesthesia care unit (PACU) until the anesthesia wears off and is closely monitored by the nursing staff.
Upon awakening from anesthesia, the patient is groggy, still has the intravenous line in place, and experiences pain in the upper abdomen. They may also be nauseated from the anesthesia and this can be relieved with medication. The intravenous line remains in until fluids taken by mouth are tolerated. Ice chips are offered first in the PACU, then water.
Generally, a patient who has undergone the laparoscopic procedure can drink and eat sooner. A patient who has undergone open surgery may not be able to drink until the next morning. From the PACU, the patient is taken to their hospital room to continue recovery until they are discharged from the hospital.
Patients who have undergone the laparoscopic procedure recover faster and experience less pain at the incision site. Sometimes the pain can be relieved with an over-the-counter remedy, such as Tylenol®. The average hospital stay is 2 to 3 days, but many patients go home the next day.
Small bandages are placed over the incisions, and there is tenderness at the sites for several days. Incisions are held together with steri-strips, which fall off a week to 10 days after surgery and showers can usually be taken within 48 hours. Most patients return to work within a week or two. Lifting heavy objects (over 25 pounds) should be avoided for the first 2 weeks. If a hiatal hernia was repaired, the patient should avoid heavy lifting for at least 6 weeks.
Those who have undergone open surgery may be in the hospital for 6 to 10 days. They feel pain at the incision site and usually need a narcotic pain reliever. Patients usually can get out of bed and take a few steps by the next day. It is important to get up and walk as soon as possible to help blood circulation return to normal and thus avoid complications such as blood clots.
Full recovery from open surgery takes 6 to 8 weeks. The 6- to 10-inch long incision must be kept dry until it begins to heal. Sponge baths are recommended during this period. The abdominal scar may fade as time passes.
Patients who have undergone fundoplication may feel bloated or constipated for a few days. During the first week, the physician may prescribe a semiliquid diet, consisting of foods such as milkshakes, puddings, and soups. Approximately one-half of patients have swallowing problems during the first 2 to 3 weeks after the operation. Once semiliquid foods are tolerated, the diet progresses to easy-to-swallow soft foods. Hard foods, such as raw vegetables and crusty bread, are avoided until the digestive tract adjusts. Most patients return to their regular diet by the end of the third week.
Some patients are advised by their physician to continue taking medications to reduce stomach acid for about a month following the fundoplication.
Abdominal cramping and flatulence, caused by increased air in the gut, may occur. Swallowed air may accumulate because the valve is tight. Cramping usually eases in a few months, but flatulence may be permanent.
Another common postoperative occurrence is feeling full very quickly (called early satiety) during meals, sometimes just after a few bites. This is because the stomach has been made smaller. Initially, patients are advised to eat and drink several small meals throughout the day to avoid overtaxing the digestive tract and make sure they are getting adequate nutrition. Over time, the stomach adjusts to accommodate a normal meal.
Most patients are satisfied with the results of surgery. Follow-up indicates that 10 to 20 years
Potential complications associated with the surgical procedure, the anesthesia, and the body's inability to recover include:
- Breakdown of the fundoplication
- Chronic swallowing problems
- Infection
- Injury to the stomach or esophagus during the procedure
- Internal bleeding
- Severe problems with bloating and belching
The surgeon should be notified of worsening pain, bleeding, drainage, or swelling around the incision site; abdominal pain not related to cramping or flatulence; and swallowing and bloating problems that persist longer than several months.
Physician-developed and -monitored.
Original Date of Publication: 01 Nov 2001
Reviewed by: Stanley J. Swierzewski, III, M.D.
Last Reviewed: 04 Dec 2007
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