Definition & Overview
Laparoscopic sleeve fundoplasty is a minimally invasive surgical procedure used to treat gastroesophageal reflux disease (GERD) and hiatal hernia, conditions that affect the oesophagus. The procedure involves wrapping a part of the upper stomach around the lower end of the oesophagus to provide symptoms relief.
Laparoscopic surgery, also referred to as laparoscopy or keyhole surgery, is one of the best alternatives to open surgery. Unlike open surgery that requires a long incision to access a particular organ, laparoscopy is performed using 5-6 small incisions. The incisions are so small that they usually do not require sutures to close.
During a fundoplasty, a partial gastric sleeve surgery is performed on the upper portion of the stomach that connects to the oesophagus. However, instead of removing the portion of the stomach that is incised to create a gastric sleeve, it is used to wrap around the lower end of the oesophagus.
There are several methods used in fundoplasty, one of which is called Nissen fundoplication. This method is the most popular as it is the most effective in eliminating the symptoms of GERD and hiatal hernia.
Who Should Undergo & Expected Results
Patients suffering from GERD with a case of type III or IV hiatal hernia can be recommended for this procedure.
GERD is a condition wherein the contents of the stomach go back into the oesophagus. The patient usually displays symptoms such as heartburn, chest pain, sore throat, swallowing difficulties, and a feeling of something stuck in the throat.
GERD can develop due to hiatal hernia, which is the enlargement of a part of the stomach near the oesophagus. The condition results in the weakening of the muscles preventing the acid from the stomach to escape into the oesophagus.
There are four different types of hiatal hernias. Types I and II are common, while types III and IV are rare forms of the condition. Since the last two types are rare, only a limited number of medical facilities have medical professionals who are proficient in treating the condition.
Most cases of these types are treated using laparoscopic Nissen fundoplication, which involves wrapping the upper portion of the stomach (fundus) around the lower portion of the oesophagus. However, Nissen fundoplication can result in a number of complications.
Laparoscopic sleeve fundoplasty, although relatively new in form and technique, promises better results and fewer complications. Based on recent studies, there were fewer cases of recurrences and fewer patients have experienced postoperative dysphagia (difficulty swallowing).
How is the Procedure Performed?
Prior to recommending sleeve fundoplasty, patients undergo a series of tests to determine the exact cause/s of their symptoms and if they are a good candidate for the procedure. It is important to note that this procedure is relatively new so there are few hospitals or medical centres that offer it.
The procedure is usually performed while the patient is under general anaesthesia. The surgeon marks 5 to 6 locations on the upper portion of the abdomen and creates small incisions that pass through the skin, muscle, and fat layers.
Tubes are then inserted through the incisions and directed towards the lower oesophageal region. Miniature surgical instruments that include a light source and video camera are then inserted into the tubes.
The surgeon then locates and repairs the hiatal hernia before performing a partial sleeve gastrectomy procedure. Once this procedure is complete, the surgeon will proceed to perform a fundoplasty, which essentially involves wrapping a part of the fundus around the lower portion of the oesophagus.
Once all procedures have been completed, the surgical instruments and tubes are removed. In most cases, sutures are not required to close the incisions.
Due to the minimally invasive nature of the procedure, patients experience an almost immediate symptoms relief. Moreover, the recovery period is significantly shorter when compared to open surgery.
Possible Risks and Complications
Although laparoscopic sleeve fundoplasty is considered a safe procedure, there is still a possibility that complications may develop. These include recurrence of the condition and postoperative dysphagia. Other risks associated with laparoscopic surgery include:
- Damage to the organs when tubes and surgical instruments are inserted into the body
- Electrical burns caused by a leak in the electrodes
- Risk of pneumonia or partial/complete collapse of the lung (atelectasis)
Luca Giordano MD, Ben Selvan MD, Kristine A Dellabadia MS;”Laparoscopic Sleeve Fundoplasty. A Novel Technique to Treat Type III and IV Hiatal Hernia with Shortened Esophagus”; http://www.sages.org/meetings/annual-meeting/abstracts-archive/laparoscopic-sleeve-fundoplasty-a-novel-technique-to-treat-type-iii-and-iv-hiatal-hernia-with-shortened-esophagus/ Le Page PA, Martin D;”Laparoscopic Partial Sleeve Gastrectomy with Fundoplication for Gastroesophageal Reflux and Delayed Gastric Emptying”; https://www.ncbi.nlm.nih.gov/pubmed/25651959
Marcin Migaczewski, Agata Grzesiak-Kuik, Michał Pędziwiatr, Andrzej Budzyński;”Laparoscopic Treatment of Type III and IV Hiatal Hernia – Author’s Experience”; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105670/
Richard A Perugini MD, Mark P Callery MD;”Complications of Laparoscopic Surgery”; https://www.ncbi.nlm.nih.gov/books/NBK6923/