What is Toupet Fundoplication

Toupet fundoplication is a procedure to treat serious symptoms of a type of severe and long-standing heartburn (gastroesophageal reflux disease, GERD). In GERD, food and acid in the stomach flow back up into the esophagus.

The esophagus is the part of the body that carries food from the mouth to the stomach.

Normally, the muscle between the stomach and the esophagus (lower esophageal sphincter, LES) keeps stomach contents in the stomach. In some people, the LES does not work properly, so stomach fluids flow up into the esophagus.

This can happen when part of the stomach bulges up through the LES (hiatal hernia).

In this procedure, the upper part of the stomach (fundus) is wrapped partially around the lower part of the esophagus and then stitched in place. This is done to strengthen the LES and help prevent reflux. You may need this surgery if other treatments for GERD have not helped or if you have a hiatal hernia that needs to be repaired. This procedure will strengthen the LES and prevent reflux.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Trouble swallowing (dysphagia).
• Bleeding.
• Infection.
• Damage to the digestive system (rare).
• Breathing problems (rare).

What happens before the procedure?

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements. You may need to stop taking some of these before your procedure, especially vitamin E.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• You may need to have tests before this procedure. These may include:
  • Blood tests.
  • Tests of your esophagus to check the pressure (manometry) and to measure how much acid is coming up from your stomach (pH monitoring).
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins. You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• Your health care provider will perform the following steps, depending on the type of fundoplication that you will be having:
  • Open procedure.
    • One long surgical cut (incision) will be made in your belly (abdomen). This allows the surgeon to work inside your stomach.
    • The surgeon will wrap the upper portion of your stomach partially around the lower portion of your esophagus and stitch them together.
  • Laparoscopic procedure. This is more commonly used than an open procedure.
    • Several small incisions will be made in your abdomen.
    • A thin tube with a camera (laparoscope) will be placed through one of the incisions. Surgical instruments will be placed through the other incisions.
    • The surgeon will wrap the upper portion of your stomach partially around the lower portion of your esophagus and stitch them together.
• If you have a hiatal hernia, it will be repaired.
• Your incision(s) will be closed with stitches (sutures) and covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will be given pain medicine as needed.
• You will slowly start to drink and eat. You may need to start gradually by beginning with liquids and soft foods that are easy to digest.

Summary

• Toupet fundoplication is a procedure to treat serious symptoms of gastroesophageal reflux disease (GERD).
• Before the procedure, follow all eating and drinking restrictions as told.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
• Your procedure will be done through one long incision (open procedure) or through several small incisions (laparoscopic procedure).
• Your incision(s) will be closed with stitches (sutures) and covered with a bandage (dressing).

Toupet Fundoplication, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Trouble swallowing or pain with swallowing.
• Gas and bloating in the abdomen.
• Gagging.
• Vomiting or trouble burping.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Do not take baths, swim, or use a hot tub until your health care provider says it is okay to do so.

Eating and drinking

• You will gradually start to drink and eat. You may need to start with liquids and soft foods that are easy to digest.

General instructions

• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
• Do not do exercise that requires a lot of effort (is strenuous) for 3 weeks or as long as told by your health care provider.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you:

• Have a fever.
• Have redness, swelling, or pain around an incision.
• Have fluid or blood coming from an incision.
• Notice that an incision feels warm to the touch.
• Have pus or a bad smell coming from an incision.
• Have pain that is not relieved by medicine.
• Have swallowing problems that are not going away.
• Have a cough that does not go away.

Get help right away if you:

• Are unable to eat.
• Have swelling or pain in your abdomen.
• Have vomiting that lasts longer than 24 hours.
• Have trouble breathing.

Summary

• After this procedure, it is common to have bloating in the abdomen and pain with swallowing for 2–4 weeks.
• Take care of your incision(s) as told by your health care provider.
• Follow instructions from your health care provider about what to eat and drink.
• Get help right away if you vomit for 24 hours or longer, have difficulty breathing, or have pain or swelling in your abdomen.