Surgery

In patients where drug therapy has been ineffective, or where there is severe bleeding and/or pulmonary complications, surgery may be required. A small incision is made close to the patient’s navel and carbon dioxide gas is used to inflate the abdomen. A laparoscope is then passed through the incision in the wall of the abdomen. The surgical procedure itself, laparoscopic fundoplication, involves wrapping the upper part of the stomach around the lower part of the oesophagus, thus reconstructing the LOS (Figure 1).

Reconstruction of the LOS by fundoplication
FIGURE 1 – Reconstruction of
the LOS by fundoplication
(click to enlarge)

Fundoplication is designed to increase the resting pressure of the LOS, thereby decreasing the number of reflux episodes, and is completely successful in >90% of patients.[Landreneau, 1998]

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