Esophagastric fundoplication

Esophagastric fundoplication

Anesthesia type	General
Airway	ETT (DLT if thoracic approach)
Lines and access	Large bore PIV
Monitors	Standard
Primary anesthetic considerations
Preoperative	Patients often Obese
Intraoperative	Severe GERD - consider RSI
Postoperative
Article quality
Editor rating	Comprehensive
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Provide a brief summary of this surgical procedure and its indications here.

Overview

Indications

• Usually for symptomatic reflux refractory to medical management

Surgical procedure

• The fundus of stomach is wrapped around the lower oesophagus

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Patient preparation and premedication

• Aspiration precautions if severe GERD

Regional and neuraxial techniques

• N/A if laparoscopic approach

Intraoperative management

Monitoring and access

• Standard monitors unless indicated by patient comorbidities
• Large bore PIV generally sufficient.

Induction and airway management

• Consider RSI
• If laparoscopic abdominal approach: ETT

Positioning

• Supine

Maintenance and surgical considerations

• Laproscopic approach: ~5 porst in upper abdomen.

Emergence

• Routine. Ensure well suctioned of any gastric contents.

Postoperative management

Pain management

• Prn multimodals

Potential complications

• Complications are rare
• Atelectasis
• Esophageal or gastric perforation
• Hemorrhage
• Pneumothorax
• Capnomediastinum

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications