Fundoplication

Fundoplication is a procedure that alleviates chronic heartburn and reflux in people whose condition cannot be controlled by either lifestyle changes or medication.  If you are one of these people, fundoplication offers a good chance of overcoming a condition that affects many areas of life, from what and when you eat, to how well you sleep and what you wear.

Fundoplication is done under a general anaesthesia. It was first performed in 1951 as an open surgical procedure requiring an incision of 6 to 10 inches long.  Patients were hospitalised for about 10 days and recuperation required up to two months.  Today, fundoplication can be performed laparoscopically (key-hole surgery).  This approach requires approximately 5 small incisions, patients experience minimal pain and recover faster and can return to employment in a week or two, depending on their type of work.

During the procedure, the fundus or upper portion of the stomach is brought around the oesophagus from behind and then sutured to create a wrap, like a collar fits around a neck. This operation is called a Nissen Fundoplication (first performed by Rudolph Nissen).  The operation is tailored to suit your oesophagus and your surgeon may choose to perform a partial wrap.  This is called a Toupet fundoplication.

In both surgical procedures the pressure at the lower end of the oesophagus increases and thereby stops reflux.

The success as measured by relief of the primary symptoms of gastro-oesophageal refux is 95%.  It is a safe and effective treatment when life-style changes and medical management fails.

Post-operative Dietary Guidelines for Laparoscopic Fundoplication
Difficulty swallowing solid foods after this operation is often experienced. The entrance to the stomach has been tightened to reduce reflux and it is especially narrow initially due to swelling.

The aim of this diet is to help you choose nourishing foods that will be small enough in size to pass easily into your stomach.

The most important things to remember are to eat slowly and chew your food well. The main problem foods are meat, chicken, and bread because they are rarely chewed into small enough pieces.

You may well have very few or no problems and will be able to progress to more solid foods quicker than expected.

This guideline will be most useful for those experiencing problems:

For 4 to 6 weeks after your operation, choose from the lists below.

A blender or food processor is very convenient for making nourishing soups or milk drinks but this is not essential.

To avoid constipation make sure you include wholegrain breakfast cereal and fruit and at least 6 to 8 glasses of fluid each day. A glass of soluble fibre (e.g. Metamucil) may also be useful.

For the first week or so it will be easier for you to puree your food and then
gradually build up the consistency over the coming weeks.

After the first week or so, if you are swallowing well, try adding overcooked pasta and rice to your vegetables and soups.

Approximately six weeks after your operation, you can progress to firmer foods.
Do so gradually. Try toast before soft bread. Try tender pieces of meat in stews or casseroles before you try steak or chops.

FOODS TO CHOOSE

FOODS TO AVOID

Breads and cereals
Sloppy soaked breakfast cereal e.g. weetbix
Overcooked white rice in liquid
Overcooked pasta and noodles
Bread
Cereal with nuts or dried fruit
Meat and meat alternatives
Finely minced pureed mince or chicken (2 weeks post-op)
Soft fish
Egg dishes e.g. scrambled egg
Other forms of meat and chicken
e.g.fried chicken or steak

Fruit
Soft, peeled, mashed or pureed fruit e.g.
banana, stewed apple, tinned peaches
Fruit juice
Fresh, firm fruit e.g. raw apple
Fruit with skin or pith e.g. grapes,
citrus fruit

Vegetables
Soft, well cooked, mashed or pureed
Potato, pumpkin, zuchini
Pureed vegetables in soups
Salad vegetables e.g. celery,
lettuce
Lightly cooked vegetables
Stir fry
Milk and dairy foods
Milk, milkshakes, fruit smoothies
Custard, icecream, rice pudding
Milk puddings, yoghurt or fruche
Cheese melted into white sauce
Soft, white cheeses
Pieces of hard cheese
Fats and Oils
Margarine, butter and oil in moderation
Crispy fried foods

SAMPLE MEAL PLAN

BREAKFAST
Soaked weetbix with milk, pureed or stewed fruit,
tea, coffee or juice

MORNING TEA
Fruit yoghurt

LUNCH
Cream of chicken soup with noodles or pureed
vegetable soup

AFTERNOON TEA
Fruit smoothie

DINNER
Mashed potato, pumpkin and zucchini
Junket with pureed fruit

SUPPER
Milo made with milk