Fundoplication is the surgical method used to correct GERD - GastroEsophageal Reflux Disease (aka really bad heartburn). The name comes from the anatomical part used (the fundus of the stomach) and the technique (plication, the gathering, wrapping, and suturing in place of said part). The most common method, to my knowledge, is the Nissen fundoplication, which may be performed either laparoscopically or through an abdominal incision or laparotomy.

One of the more common reasons for GERD is laxity of the lower esophageal sphincter, which allows gastric juices (which, essentially, are hydrochloric acid) to leak out of the stomach and up into the esophagus, causing severe pain, burning, and frequently contributing to asthma. This is what fundoplication is designed to correct.

During the operation, the surgeon frees the base of the esophagus from the diaphragm and the ligaments that keep it from bouncing about as you move. He then uses the fundus to basically tighten the lower esophageal sphincter by wrapping it around the base of the esophagus and suturing it in place. If a full 360 degree wrap is used, the procedure is a Nissen fundoplication; if a partial wrap is performed (such as for some patients with esophageal motility problems, i.e. swallowing difficulties, it is a Toupet fundoplication

If the patients are screened to ensure that sphincter laxity is, indeed, the cause of their GERD, fundoplication has a 95% success rate. Complications include hemorrhage, infection, and food becoming lodged in the esophagus due to too-tight wrapping. This can generally be corrected endoscopically, by using a series of lead-weighted dilators to stretch the sphincter opening.

I just had this done to me. Would you like to hear about my operation? Good, well, sit down and I shall begin.

For those of us who suffer from chronic GERD which has led to the pre-cancerous condition known as Barrett's oesophagus, it is a good thing to have done. Although, apparently it's not necessarily permanent. It might need topping up after a decade or two.

I went into hospital on Thursday morning, was on the operating table a couple of hours later and back on the ward by the afternoon. Friday was pretty grim, Saturday was fine, On Sunday I got bored on the ward and by today I was threatening to walk out of the hospital unless they let me go. So now I'm at home, noding it.

In theory this was going to be a laparoscopic operation (Keyhole surgery to anyone who is not a medic). In practice, my surgeon tried for an hour to dig through some old scar tissue before giving that up as a bad job and slicing me up the middle.

In time-honored Blue Peter tradition, let me tell you want you need.

Start out with a 50-year-old bloke who has drunk a bit too much, has recently started putting on weight and complaining of reflux. Run a load of tests on him stuff tubes down his gullet, photograph his innards, push, poke, prod until most of the dignity has been removed. Then book a surgeon and an operating theatre.

Bring the old bloke, the surgeon, the operating table and some knives together, preferably on the same day, and pay the surgeon to do some surgery. It's what they do, so the instructions don't need to be too clear. It's best. however to make sure the old bloke is separated from the surgeon. Some surgeons are old blokes. If you get them the wrong way around, the operation is unlikely to work properly.

Finally, pat the ageing bloke on the head and tell him to recover in peace.

That was more or less it, and it seems to work well enough.

What I would have asked if I had a time machine

This is good advice, if you ever need one of these.

I have scar tissue in the area from a previous operation. Does this matter?

Yes. Despite all the pre-op checks where I always gave as much information as I could, no-one ever asked about old scar tissue. I mentioned it to the surgeon an hour before the operation, as it had been mentioned by another patient, and he seemed surprised that he had not been told earlier. The relevant area is close to the navel or on the midriff. Scar tissue does not appear just on the surface. It permeates throughout the skin, and well below that. Bits of the body which should separate easily become fused. Scar tissue is really tough to cut through. Surgeons hate having to work through the stuff.

Will my uvula be OK afterwards?

No, your uvula will not be OK. It will almost certainly be a mess. A revolting, damaged, maggot-like growth, sprouting down from the top of your throat. It will feel creepy. It will stop you sleeping and lead to you almost drowning in your own saliva. From this sample of one, the damaged uvula is a certainty.

other sample sizes might produce different results. Do not mistake the uvula for a vulva or even an ulu..

The uvula, if you did not know, is the dangly thing at the back of the throat that cartoonists draw when they want to show a baby crying VERY LOUDLY. In my case, it became the collateral damage of the operation. No idea how it got damaged, but the surgeon said it probably got crushed behind the tube they poke down your throat. The uvula ended up twice its normal length and bruised in a big way. That meant it reached well past my tongue into my throat (ewww).

By expelling air, I could blow it up onto my tongue where it would throb quietly, doing an impressively life-like impersonation of a pulsating maggot from some dreadful nature programme about parasites. When sleeping, it irritated the throat, leading to saliva production. During the night I therefore had the choice of staying awake and swallowing every few minutes, or falling asleep and waking with a cough and a splutter after five minutes (I timed it many many many times), as the saliva built up and the body's normal reactions led me to wake up.

By the fourth night post-op, it has settled a bit and I was able to sleep sitting up, so that the enlarged uvula dangled down the throat without stimulating saliva production.

Will it hurt?

Yes, but not as much as you might think. Painkillers today are pretty amazing - especially the oral ones.

Will I be able to swallow anything, like painkilling drugs, for example

No, nothing at all. If you do manage, it, it will be incredibly painful for anything larger than a tiny tiny thing. Swallowing something as big and hard as a small pill will be excruciating.

For about 48 hours post-op any swallowing was seriously challenging. Swelling does not just happen in external organs damaged by some trauma. It happens to internal organs too. And with swelling, that sphincter valve is shut off like .. ummm, like a tightly shut-off valve. It does not want to let anything through. Warm sweet tea will just about pass in doses of a teaspoonful at a time. Everything else hurts, and hurts bigtime.

Painkillers came in the form of large, hard paracetamol tablets. Until I complained. Then I got the real deal: some liquid, gin-flavoured morphine. That worked like a shot. Which is what it was, in effect. No-one suggested I divide the large tablets into 4 smaller ones, or crumble them into some water. I had to work that out for myself.

So why not use water-solubles?

In a word, gas. Those of us with loose sphincter valves have become used to releasing copious amonts of wind from the top of our stomachs. As a kid my party trick was to swallow air and release it at the same time as humming a tune. Quite revolting of course, but the other lads thought it funny. Anyway, I think most of us know what trapped wind feels like. Imagine having a top stomach sphincter that does not want to open for anything, and a large amount of gas stuck behind it. That hurts.

What will I be able to eat?

Not a lot, but then you won't feel like eating much. One side effect of the procedure is that the stomach shrinks, as some of it is used to wrap around the sphincter. Follow any specific advice, but small helpings of soups, ice cream, and such like all work. More important, however, is to break from having food in two three or four specific batches during the day, and switch to continuous grazing. Fruit such as bananas, peaches or melon works well, but in each case, chew it right to a pulp and only small amounts in each mouthful.

After two or three days the internal swelling goes down and more interesting food becomes a possibility. The best guide I could find on the web was from a private surgical unit in Bristol: http://www.bristolsurgery.com/Page.aspx?id=163

Personally I lost a much-needed 5kg in hospital, I need to lose at least another 5kg, so I'm not going to try to expand my stomach if I can avoid it.

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