Fundoplication is a surgical procedure in which the fundus (uppermost portion) of the stomach is wrapped around the lower esophagus to strengthen the lower esophageal sphincter (LES) muscles and prevent acid reflux. The fundus of the stomach is used as a wrap because both it and the LES relax with swallowing.

Food enters the body through the mouth and travels through the esophagus before entering the stomach. The presence of food in the esophagus triggers the LES muscles to relax, allowing the food to pass into the stomach. The LES then closes to prevent stomach acid and contents from washing back up into the esophagus. In this way, the LES works as a one-way valve that aids digestion.

When LES muscles are unable to sufficiently tighten, the LES fails to properly close and stomach acid may travel back up into the esophagus, causing irritation and inflammation of the lining of the esophagus. When this occurs repeatedly, the condition is known as gastroesophageal reflux disease (GERD). 

A fundoplication procedure is most commonly performed on patients with GERD. It may also be performed on patients with esophagitis (inflammation of the esophagus) and is sometimes used to repair a hiatal hernia, a condition in which a portion of the stomach protrudes into the chest cavity through an opening in the diaphragm (a muscle that separates the chest from the abdomen).

Hiatal hernias are often associated with GERD and esophagitis, and may worsen the symptoms of those conditions. If a hiatal hernia exists, it is pulled down from the chest during a fundoplication, and the area of the diaphragm where the stomach protruded into the esophagus is tightened to prevent recurrence.

Fundoplication is often performed on patients who have developed complications from GERD or esophagitis, such as stricture (narrowing of the esophagus) or Barrett’s esophagus (precancerous condition that affects cells that line the esophagus). It may also be performed on patients suffering from reflux-induced airway problems. These include asthma-like symptoms such as difficulty breathing or pneumonia caused by gastric fluids being inhaled into the lungs.

Surgery may be recommended for patients who have not responded to other treatments, such as lifestyle modifications (e.g., diet, exercise) and medications. Some patients choose to have fundoplication as an alternative to lifelong use of GERD medications or because they cannot tolerate GERD medications.

Fundoplication may not be an option for the elderly, who face increased risk of injury or death during surgery. It also may not be appropriate for patients with existing problems (e.g., bloating, impaired movement of food through the esophagus) that may be worsened with surgery.