Laparoscopic fundoplication in Hyderabad, India | Cost & Procedure Benefits
PACE Hospitals is recognized as the best hospital for laparoscopic fundoplication surgery in Hyderabad, Telangana, India, with a focus on patient safety, precision, and long-term relief from GERD. Our highly experienced surgical gastroenterologists and GI surgeons specialize in minimally invasive techniques, ensuring reduced pain, faster recovery, and excellent surgical outcomes.
Equipped with state-of-the-art technology, including a 3D HD laparoscopic system and AI robotic system, we offer personalized treatment plans, comprehensive post-operative care, and a high success rate in acid reflux management. With affordable pricing and a patient-first approach, PACE Hospitals is the top choice for Laparoscopic Nissen Fundoplication (GERD) Surgery in Hyderabad, India.
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What is Laparoscopic Fundoplication?
Laparoscopic nissen fundoplication meaning
The laparoscopic fundoplication procedure is the most common keyhole surgery performed by gastro surgeons to treat the heartburn (acid reflux) of Gastroesophageal reflux disease (GERD) and hiatus hernia.
It involves wrapping the oesophagus with the top part of the stomach to strengthen the valve muscle between the oesophagus and stomach, thereby preventing the stomach acids or contents from being forced back into the food pipe. If the patient has a hiatus hernia, this condition will be repaired simultaneously.
Lower oesophageal sphincter
Usually, the lower oesophageal sphincter is the valve between the oesophagus and stomach, which acts as a single-way valve and only opens when the person is swallowing. At other times, it remains closed and avoids the backup of any stomach secretions into the food pipe.
There is a possibility of the sphincter becoming too loose or that the opening in the diaphragm muscles surrounding it is too broad.
If this sphincter becomes weakened or relaxes abnormally, it creates a situation of stomach secretions refluxing and causes associated symptoms such as acid reflux or even herniation/bulging of a person's stomach through this opening into the chest. These conditions can damage the oesophagus and cause discomfort.
These changes in the lower oesophageal sphincter may be worsened by a hiatal hernia, which occurs when a portion of the stomach projects through the diaphragm and goes into the chest. Surgeons resolve this problem by tightening the sphincter by wrapping the top portion of the stomach around the oesophageal sphincter to reinforce the valve, prevent acid reflux and allow the oesophagus to heal. This procedure delivers a high percentage of successful outcomes in correcting this condition.
If the patient only has heartburn and regurgitation, surgery may not be required all the time because medical therapy can treat it. However, if the person is describing chest pain and respiratory symptoms (choking, difficulty breathing), then surgery is recommended.
Types of fundoplication
Types of fundoplication are divided into several types depending on the extent and type (anterior or posterior) of wrapping, including:
- Toupet 270° posterior fundoplication
- Nissen 360° posterior fundoplication
- Dor 180-200° anterior fundoplication
- Thal 270° anterior fundoplication
Toupet 270° posterior fundoplication (Laparoscopic Toupet fundoplication)
Toupet fundoplication is the surgery to treat GERD. This procedure involves wrapping the top of the stomach about 270° degrees around the back side or posterior or bottom of the oesophagus to strengthen sphincter and prevent acid reflux.
It is a minimally invasive procedure where tiny incisions are made to wrap to easily release pressure, such as gas, through the burps or vomit to prevent pain and complications.
Nissen 360° posterior fundoplication (Laparoscopic Nissen fundoplication)
Nowadays, laparoscopic Nissen fundoplication is the 'gold standard' for managing GERD (Gastro oesophageal reflux disease) in patients who do not respond to medications completely or in those who are not able to take medications. It is considered the most commonly performed anti-reflux procedure.
This surgery helps to stop the reflux of digestive acids that the medicines cannot treat. If the patient has a hiatal hernia, it is fixed at the same time as the Nissen fundoplication.
This procedure involves wrapping the top of the stomach about 360° degrees around the bottom of the patient's oesophagus to strengthen the sphincter. This procedure will prevent vomiting or burping acid reflux.
Even though this surgery controls reflux, it also causes complications such as difficulty in swallowing (dysphagia) and bloating. In some patients, these complications may persist after the procedure. Research suggests that up to 10% of individuals who have a Nissen procedure still experience dysphagia a year later, and between 1% and 10% of individuals require another operation.
Laparoscopic hiatal hernia repair with fundoplication: For para-oesophageal hiatus hernia, it is advised as the first solution to treat the condition. This procedure is also performed by using robotic technology called robotic assisted laparoscopic Nissen fundoplication.
Dor 180-200° anterior fundoplication
It is one of the most common antireflux surgical procedures that involves wrapping the stomach's upper part around the oesophagus in an anterior 180–200-degree fold, which can be performed along with 270-degree posterior Toupet fundoplication.
It is used to treat refractory gastroesophageal reflux disease (GERD), severe gastroparesis, and achalasia. It also improves sphincter competency, reduces the risk of vagal nerve damage, and prevents gas bloat syndrome.
Thal 270° anterior fundoplication
It is a 180–270° anterior wrap similar to any other fundoplication used to treat gastroesophageal reflux disease (GERD). It includes wrapping the top part of the stomach around the lower oesophagus to avoid acid reflux; however, it requires less dissection than other methods.
It achieves the same surgical goals as other types of fundoplication’s, such as intra-abdominal oesophagus (keeping the oesophagus inside the abdomen) and creating a high-pressure area to prevent reflux.
It is more effective in normal children but less successful in children with neurological issues compared to the Nissen fundoplication. However, it generally leads to less difficulty swallowing after the procedure.
Laparoscopic fundoplication Indications
Laparoscopic fundoplication is the standard treatment for patients who don't respond to or cannot take medicines. It is mainly indicated in the following conditions:
- Failure of medical therapy for GERD: If medical treatments are unsuccessful, fundoplication (wrapping) is commonly performed for GERD to tighten the oesophageal sphincter, which can help stop backflow of acid into the oesophagus.
- Hiatal hernia repair: Fundoplication’s are also commonly performed as part of hiatal hernia repair. Levels of oesophageal acid and function of oesophageal muscle will be tested before the surgery to check whether this surgery will help symptoms and determine the best strength of wrap for the patient.
Other indications include
- Refractory to medical management: In some people, after stopping the medicine, GERD may reoccur
- Intolerance to H2 receptor antagonist or PPH receptors
- Repeated aspiration pneumonia or asthma-related reflux
- Barett oesophagus (controversial)
- Unable to take medications due to compliance or side effects
Laparoscopic fundoplication contraindications
This procedure is contraindicated in patients who have the following conditions:
Absolute contraindications for laparoscopic Anti-reflux surgery (Laparoscopic fundoplication):
- Inability to tolerate general anaesthesia due to other underlying medical conditions
- Uncorrectable coagulopathy
- Portal hypertension
Relative contraindications for laparoscopic Anti-reflux surgery:
Considerations of gastro surgeon before planning fundoplication
Generally, before performing the surgery, doctor considers various aspects such as patient’s age, overall health etc to understand the necessity of the procedure. Nevertheless, three common criteria which could alter the decision of the surgeon include:
- Symptom evaluation
- Status of lower oesophageal sphincter
- Presence of acidity
Symptom evaluation: Instead of the surgical procedure the gastro surgeon opts medical therapy to the patient who presents with only symptoms such as heartburn and regurgitation.
In some cases, patient may experience chest pain, respiratory symptoms along with heartburn and regurgitation which may not consider as normal, then this situation can meet the one of the criteria to considering for surgery.
Status of lower oesophageal sphincter: Before planning the surgery, the physician performs the basic diagnostic tests such as endoscopy and barium swallow test to confirm the GERD condition. Upon confirmation, the physicians prescribe other tests such as oesophageal transit +/-- manometry to check the status of lower oesophageal sphincter.
In case of a functional sphincter the patient may not be considered for this surgery as laparoscopic fundoplication could not only worsens the healthy sphincter condition but may cause dysphagia (difficulty in swallowing).
Presence of acidity: Dual probe ambulatory lower oesophageal PH monitoring will be performed by the healthcare professional to check the patient’s PH of digestive contents. In case of a neutral or near neutral PH, surgery may not be considered.
Unavailability of advanced diagnostic procedures and tests could prompt the physician to judge the condition clinically and through evidence-based medicine and calculating the risk benefit analysis, the physician proceeds for surgery.
A healthcare professional will discuss the goals of surgery, the risks, benefits, alternative treatments and life after surgery to provide a general understanding to the patient, before undergoing surgery.
Laparoscopic fundoplication surgery Procedure
Before the laparoscopic fundoplication surgery
Before the surgery, the patient must consult the gastro surgeon and discuss risks, benefits, options and costs. It includes the patient's medical medication history, and the gastro surgeon will perform physical examinations and tests before surgery.
A patient has to maintain a healthy weight, because being overweight can develop the risk of complications. Smoking also increase the risk of complications. To reduce the risk, the patient has to quit smoking before having surgery.
During the week before surgery, patients may be asked to stop taking blood thinners and other drugs that put a person at a higher risk of bleeding during surgery.
Before the day of this procedure, blood was drawn from the patient, and a urine sample was taken. This will help the gastro surgeon to look for conditions that may cause complications.
The gastro surgeon will take written consent for the operation from the patient. Before the surgery, blood pressure or diabetes will be checked and well controlled.
All the queries related to laparoscopic fundoplication procedure and post-operative care will be clarified by healthcare team.
During the laparoscopic fundoplication procedure- Laparoscopic fundoplication steps
Laparoscopic Nissen fundoplication procedure steps include:
General anaesthesia will be given to the patient before performing the surgery to make the patient unconscious. The duration of the procedure can vary but is usually one to three hours. It is a keyhole surgery performed by making the five tiny incisions in the abdomen to insert a laparoscope and some surgical tools whereby watching the video on a monitor by gastro surgeons.
Gastrointestinal surgeons retract the liver and carefully dissect adhesions and ligaments to reveal the stomach and the opening in the diaphragm through which the oesophagus should pass.
Then, Gastro surgeons release the stomach to mobilize it and wrap it around the oesophageal sphincter. They also free up the oesophagus in the lower chest, carefully retract it, and partially sew the crus of the diaphragm (two tendinous structures) together to make the diaphragm opening a little tighter.
The top portion of the stomach will be wrapped around the oesophagus and sutured to reinforce the oesophageal sphincter. Afterwards, surgeons ensure the wrap is not too tight. Then, all the laparoscopic instruments will be removed, and incisions will be closed. Care must be taken during dissection to avoid damaging the surrounding nerves and arteries.
Sometimes, during the surgery, a gastric tube will be placed between the stomach and abdominal wall, helping to anchor the stomach to the abdominal wall to prevent the stomach from rising into the chest. It has the added benefit of being able to vent fluid and air from the stomach, which can help reduce discomfort.
Generally, this tube is temporary and will be removed once the track has formed. For specific medical conditions involving the oesophagus, such as achalasia in which the oesophageal sphincter does not relax like it is supposed to, A heller myotomy may also be performed. This is a procedure in which gastro surgeons make an incision in the oesophageal sphincter muscle.
Rarely, a larger abdominal wall cut may be required if the process cannot be completed safely through the smaller incisions.
After the laparoscopic fundoplication procedure
The laparoscopic procedure is usually carried out as daycare or with an overnight stay. The patient will be returned to general ward after staying sometime in the recovery area of the operating suite. Nurses will monitor the patient's progress and give painkillers.
After this procedure, the patient may leave the hospital later that day, based on how well the patient is recovering from the operation and anaesthesia. Laparoscopic Nissen fundoplication recovery may vary from person to person, usually a patient can return to work within 1 - 2 weeks after this operation.
After the procedure, gastro surgeons will advise the following:
- Prevent lifting weights more than 10 pounds for at least four weeks.
- Prevent excessive twisting or bending for 1 - 2 weeks
- Have small, frequent meals (6 to 8/day)
- Take food in small bites and chew thoroughly
- Drink half cup of fluid with meals
- Sit and stay upright for 30 minutes while having food
- Avoid alcohol, carbonated beverages for 6-8 weeks, caffeine, citrus juices and fruits, chocolate and tomato products
These are the following foods that a patient can include:
- Patients advised to take a full liquid diet, such as milk, cream of rice or wheat, plain yogurt, vanilla ice cream, apple, grape and cranberry juice, decaf tea, chicken and beef broth.
- A patient's diet will be limited to a strict diet, to control the excess gas, swallowing issues and diarrhoea.
If the patient is experiencing following conditions, it is suggestable to consult gastro- surgeon:
- Vomiting
- Infection
- Abdominal swelling
- Increased temperature
- Poor urine output
- Difficulty swallowing
- Severe pain
- An oozing wound
Laparoscopic fundoplication complications
This procedure has multiple complications, including accidentally damaging the stomach or oesophagus, these are the following other possible complications:
- Bleeding
- Dysphagia (difficulty in swallowing)
- Abdominal bleeding or increased amount of gas is common
- Gas-bloat syndrome
- Diarrhoea
- Recurrent symptoms: Almost 10 percent of patients continue to experience the symptoms of GERD, such as heartburn, difficulty swallowing, chest pain, coughing etc.
Rare complications of laparoscopic fundoplication include:
- Injury of the patient's lung or spleen
- Difficulty breathing
- Pneumonia
These complications may develop during the 3-6 months after surgery. Dietary changes, medicines and oesophageal dilation will be helpful to manage these complications.
Risks of the laparoscopic fundoplication procedure
Generally, laparoscopic fundoplication is considered safe because of its low mortality rate. However, like any other surgery, this laparoscopic fundoplication surgery also has some possible side effects, risks and complications. Hence, the patients who have undergone this procedure are more likely to develop the following risks:
- Significant bleeding: One may require hospitalization, blood transfusion or, in some cases, return to the operating room.
- Infection: A risk that can occur in the surgical site or other parts of the body. IV antibiotics will be given right before the surgery to decrease the risk. Even with an uncomplicated fundoplication, infection may still occur.
- Difficulty belching or swallowing: Some people experience this procedure, if the wrap is too tight, causing bloating and discomfort from gas.
- Recurrence of acid reflux: Sometimes, the oesophagus can slip out of the wrapped portion of the stomach, so the oesophageal sphincter is no longer supported. This can cause a recurrence of acid reflux.
Occasionally, the lining of the lung will be damaged while freeing up the lower oesophagus; this can result in a small amount of air leaking into the space around lung. This will usually reabsorb and heal on its own without treatment, but if a large amount of air is present, it could need decompression with a needle or a small chest tube.
Other possible risks that include:
- Hernia formation at incision sites
- Injury to the intestines, liver, spleen, vagus nerve or other nearby structures
- Blood clots in the legs or lungs
- Clots from the legs can travel to the lungs.
- Very rarely death.
Questions that the patients can ask the healthcare team about laparoscopic fundoplication surgery?
- What is laparoscopic fundoplication procedure?
- Why do I need laparoscopic fundoplication surgery?
- What are the risks and benefits of laparoscopic fundoplication surgery?
- How safe is laparoscopic fundoplication procedure?
- What kind of diet I should follow post procedure?
- When should I visit back for follow-up?
- When can I go back to my work?
- What are the different surgical options available for laparoscopic fundoplication?
- What are the benefits of having this procedure?
- What are the potential risks and complications associated with laparoscopic fundoplication?
- What is the expected recovery time after laparoscopic fundoplication?
- Who can get the procedure done?
- Is it a dangerous procedure?
- Is laparoscopic fundoplication costly?
Difference between Open fundoplication and Laparoscopic Fundoplication
Open vs laparoscopic Nissen fundoplication
Laparoscopic fundoplication and open fundoplication are both effective procedures helpful in treating the GERD. Although these are similar, they have some differences:
| Aspects | Open Fundoplication | Laparoscopic (keyhole) Fundoplication |
|---|---|---|
| Procedure | It involves wrapping the oesophagus with the top part of the stomach to strengthen the valve muscle between the oesophagus and stomach, without laparoscope | It involves wrapping the oesophagus with the top part of the stomach to strengthen the valve muscle between the oesophagus and stomach by using laparoscope |
| Fundoplication incision | A single, large incision in abdomen | Four or five small incisions in the abdomen (The number of cuts and their positions may differ from person to person) |
| Invasiveness | More invasive | Less invasive |
| Hospital stays | 3-4 days | 0-1 day |
| Recovery time | Longer recovery time (6-8 weeks) | Shorter recovery time (1-2 weeks) |
| Risks | High risks | Low risks |
| Duration of procedure | 30-90 mins | 1-2 hrs |
| Post-operative pain | More postoperative pain | Less postoperative pain |
Laparoscopic Fundoplication Surgery cost in Hyderabad, India
Laparoscopic fundoplication surgery cost in Hyderabad, India, ranges from ₹1,05,000 to ₹2,75,000 (US$1200 to US$3150). The final GERD surgery cost depends on various factors, including hospital infrastructure and facilities, surgeon expertise, patient’s age and medical condition, pre-surgery diagnostic tests, hospital stay, post-operative care, and follow-ups.
At PACE Hospitals, we offer affordable, high-quality GERD treatment with advanced laparoscopic technology and expert surgical care.
We offer cashless treatment options and accept major health insurance plans to make GERD surgery more accessible.
Frequently Asked Questions (FAQs) on laparoscopic fundoplication
Is laparoscopic fundoplication a major surgery?
Yes, laparoscopic fundoplication is thought to be a major procedure despite it being minimally invasive.
It is recommended to choose a skilled and experienced gastro surgeon in an accredited facility with ICU and ventilator backup. So, it is advised to always check the gastro surgeon's credibility and hospital facility before getting the surgery because it is executed under general anaesthesia and can take one to three hours to complete. During the procedure, the gastro surgeon makes several tiny incisions in the abdomen and inserts a surgical tools to perform surgery and a laparoscope to see the process on the monitor.
How successful is laparoscopic fundoplication?
Laparoscopic fundoplication has been highly successful in 90% of GERD patients who have symptoms like acid regurgitation and heartburn, which provides relief symptoms and improves the quality of life.
However, this procedure is ineffective in treating the atypical symptoms of GERD, such as hoarseness, cough and sore throat, as it is effective in treating the typical symptoms (acid regurgitation and heartburn). Patients with atypical symptoms will have a concrete diagnosis of acid reflux before having a laparoscopic fundoplication surgery to improve the chances of success.
What are the complications of fundoplication?
Laparoscopic fundoplication is considered safe because of its low mortality rate. However, like any other surgery, this laparoscopic fundoplication surgery also has some possible side effects, risks and complications. Hence, the possible late complications of laparoscopic fundoplication include:
Gas-bloat syndrome (up to 85%)
Diarrhoea (18%-33%)
Recurrent heartburn (10% - 62%)
Dysphagia (10%-50%)
These complications may develop during the 3-6 months after surgery. Dietary changes, medicines and oesophageal dilation will be helpful to manage these complications.
What is laparoscopic fundoplication surgery?
Laparoscopic fundoplication is the common surgery to treat GERD. It is the standard treatment for patients who don't respond to or cannot take medicines.
It is a keyhole surgery performed through tiny incisions by watching the video on a monitor. During the process, the top of the stomach (fundus) is wrapped around the bottom of the oesophagus, resulting in the repair of the valve at the end of the oesophagus that doesn't work properly in GERD patients.
This surgery helps to stop the reflux of digestive acids that the medicines cannot treat. If the patient has a hiatal hernia, it is fixed at the same time as the Nissen fundoplication.
What does laparoscopic fundoplication do?
Laparoscopic fundoplication is performed to treat GERD (Gastroesophageal reflux disease), where the stomach acid flows back into the gullet, resulting in symptoms like regurgitation, heartburn and irritation. It is the standard treatment for patients who don't respond to or cannot take medicines.
Most of the patients who have the surgery have seen an improvement in reducing the symptoms. This surgery helps to stop the reflux of digestive acids that the medicines cannot treat. If the patient has a hiatal hernia, it is fixed at the same time as the Nissen fundoplication.
What is GERD?
Gastroesophageal reflux disease (GERD) a is a typical condition that affects many people in modern days which is characterised by the backup of contents or stomach acid into a food pipe called the oesophagus, and this condition can weaken the muscles that help to move food into the downward side (stomach). It also weakens the sphincter, which closes the opening between the stomach and the oesophagus.
What are the risks of laparoscopic Nissen fundoplication?
Like any other surgery, this laparoscopic Nissen fundoplication surgery also has some possible risks and complications. Hence, the possible complications of laparoscopic Nissen fundoplication include difficulty swallowing, Infection, bleeding at the surgical site, accidental slipping of wrapped portion of the stomach, unintended puncture or tearing of the lining of the oesophagus and difficulty belching.
Is laparoscopic fundoplication painful?
The patient may have soreness and some pain in the abdomen (surgical site) for several weeks after the laparoscopic fundoplication surgery. Some patients may experience pain near the shoulder for a day or two after the procedure, and it may be hard for these patients to swallow food for up to six weeks.
What is Nissen fundoplication?
Nissen fundoplication is a surgical method to treat GERD (Gastroesophageal reflux disease) and hiatus hernia. This procedure involves wrapping the top of the stomach about 360 degrees around the bottom of the patient's oesophagus to strengthen the sphincter.
- For GERD, it is performed in the patients who don't respond to or cannot take medicines.
- For para-oesophageal hiatus hernia, it is advised as the first solution to treat the condition.
This procedure will prevent vomiting or burping acid reflux.
How long does laparoscopic fundoplication last?
This procedure is performed under general anaesthesia and can take one to three hours to complete where the gastro surgeon makes several tiny incisions in the abdomen and inserts a surgical tool to perform surgery and a laparoscope to see the process on the monitor.
However, the duration of laparoscopic fundoplication surgery may differ from person to person based on several factors, including the experience of the gastro surgeon, the complexity of the case, the patient's overall health condition and age.
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