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TOFS Awareness Week 2024

Fundoplication

Most OA/TOF babies will reflux.  Reflux is the return of stomach  contents back up the oesophagus. Minor degrees of reflux are common in all newborn babies which is why they possit (bring up small mouthfuls of milk after feeding).

Gastro-oesophageal reflux (GOR) is caused by weakness of a valve at the top of the stomach called the lower oesophageal sphincter. This is another common problem seen with oesophageal atresia. Sometimes stomach acid regurgitates up the oesophagus where it can cause inflammation and pain.

In adults, this causes heartburn. In babies, it can discourage them from feeding. 

A variety of medicines and food thickeners are used to treat reflux. However, if medication does not control the symptoms, particularly if reflux is causing recurrent aspiration and chest infections, anti-reflux surgery may be necessary.

This surgery is called fundoplication.

The basic elements of the options available are similar:

  • Restore the intra-abdominal segment of oesophagus.
  • Repair the oesophageal hiatus in the diaphragm by tightening the crural muscles behind the oesophagus. These two measures repair a hiatus hernia, if one is present.
  • Wrap the top of the stomach (the ‘fundus’ of the stomach) around the bottom of the oesophagus.
    This is the fundoplication part of the operation.

The fundoplication wrap recreates a valve between the oesophagus  and stomach. It also restores the angle of His (the angle between the stomach and the oesophagus).

The wrap should be loose so that when the stomach is relaxed and the oesophagus squeezes during swallowing, the contents of the oesophagus pass freely into the stomach.

When the stomach contracts to empty, the wrap also contracts, closing the lower oesophagus and preventing reflux of gastric contents.

Types of fundoplication

There are several variations of the fundoplication operation, each referred to by the name of the surgeon who first described it:

Nissen was a German surgeon who described a fundoplication with a 360° wrap in the 1960s. This operation is probably the one most often performed in the UK today.

Toupet, Watson and Thal operations involve partial wraps around the oesophagus. The potential advantage of a partial wrap is a lower incidence of dysphagia (difficulty swallowing solids) after surgery, although this may be at the cost of a less efficient barrier to reflux.

fundoplication examples
Examples of full wrap and partial wrap fundoplication

Would you like more information?

Published by TOFS, The TOF Book is the must have guide for anyone affected by, or caring for someone with OA/TOF.

With contributions from medical experts, the TOF Book contains chapters on every aspect of OA/TOF and VACTERL condition, from infancy to adulthood all presented in an easy-to-understand format.