Fundoplication

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.

Technique

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 re-enforced lower esophageal sphincter in the abdomen .

Types

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

Radiographic features

Barium study of the upper GI 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 locates below the diaphragm and no more than 2 cm in length. There should be proper esophageal emptying and no gastric reflux.

Complications

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