During the operation for myotomy, surgeons often perform an additional procedure called a fundoplication in which a portion of the stomach is wrapped around the esophagus to prevent the reflux of stomach contents (figure 3). However, the fundoplication does not always prevent reflux, and it can cause additional complications such as difficulty swallowing, bloating, flatulence, and diarrhea. (See "Patient information: Acid reflux (gastroesophageal reflux disease) in adults (Beyond the Basics)".)