-The anti-gastroesophageal reflux surgery involves folding the gastric fundus around the esophagus, creating an area of high pressure in the distal esophagus, whether in the intra-abdominal or intrathoracic position.
-Fundoplication according to Nissen is the most common procedure performed. This 360 degree fundoplication is very effective, it gives 90 to 95% good results from the point of view of heartburn by increasing the lower esophageal sphincter, by improving the amplitude of contraction of the lower third of the esophagus and by improvement of gastric emptying. The anti-reflux valve prevent food and acid from rising from the stomach to the esophagus.
-Fundoplication according to Toupet is a 270 degree posterior wrap. The fundus is wrapped about two-thirds of the way around the back side, or posterior, on the lower part of your esophagus. This creates a sort of valve that lets you more easily release gas through burps or vomit when necessary like in case of abnormal esophageal peristaltic.
-In a Dor fundoplication, the fundus is laid over the top of the esophagus in anterior position
-Preoperatively, it usually recommended to prescribe a gastroscopy with biopsy, an oeso-gastroduodenal transit and a manometry to rule out achalasia or severe scleroderma; minor esophageal motor abnormalities are common with reflux. The type of valve is determined by this assessment.
• Day0- After the surgery the patient will stay on an empty stomach or he can drink water for his comfort
• Day1- If the patient has a drainage coverslip placed near the assembly, a methylene blue test is performed during the morning; a negative test does not replace the control x-ray.
– An oeso-gastro-duodenal transit is essential to demonstrate the configuration of the valve, the correct intra-abdominal positioning and also the absence of an extradigestive leak at the esophageal or gastric level. If the exam is normal, a liquid diet is allowed and possibly a return home.
• Dysphagia and stomach emptying disorder – are usual, occurring every other time, and usually disappears within 6 to 10 weeks.
• Digestive leak – May be following an esophageal perforation or following a gastric perforation.
• Bleeding – should be suspected in a patient who presents with hypotension, tachycardia, tight urine output or shock.
• Pneumothorax and pneumomediastinum – May result from extensive trans hiatal mobilization of the esophagus, in the context of a large hernia.