Nissen Fundoplication

Overview

A Nissen fundoplication is a surgical procedure designed to treat Gastroesophageal Reflux Disease (GERD). This operation involves tightening the junction between the esophagus and the stomach to prevent acid from flowing back into the esophagus. The esophagus, a tube connecting the mouth to the stomach, is a crucial component of the gastrointestinal (GI) system. GERD, also known as chronic acid reflux, is a digestive disorder that causes stomach acid and contents to frequently back up into the esophagus.

Types of Nissen fundoplication

• Laparoscopic procedures involve making small incisions and using cameras to view the interior of the body.
• Open procedures require larger incisions, allowing the surgeon to use bigger instruments and have greater range of motion inside the body.

Reasons for undergoing the procedure

In some cases, medication or lifestyle changes can alleviate acid reflux symptoms. However, if these noninvasive treatments prove ineffective, your doctor may recommend Nissen fundoplication surgery. This procedure can be suitable for both adults and children.

Risks

The primary risk associated with Nissen fundoplication surgery is that it might not always offer long-term symptom relief. Some individuals may need additional surgeries within a certain period. As with any surgical procedure, there is also a risk of incisional site infection.

Before the procedure

It’s possible that your surgeon will prescribe tests to check your esophagus and stomach prior to Nissen fundoplication.

• Barium swallow X-rays, also known as GI X-rays, scan your stomach, small intestine, and esophagus.
• Esophageal manometry gauges the amount of pressure inyour esophagus during swallowing.
• The upper portion of your stomach is examined during an upper endoscopy.
• A pH probe to check for acid levels in the esophagus.

These tests are used by doctors to evaluate any constriction of the esophagus. These tests could also be ordered in order to check for a hiatal hernia. The top of the stomach protrudes into the esophagus in this disease. Severe GERD symptoms may result from hiatal hernias.

The night before surgery, your doctor will give you or your child instructions not to eat or drink anything after midnight.

During the procedure

Depending on whether your surgeon performs an open or a laparoscopic procedure, there are slight differences in what happens during your surgery. An anesthesiologist will initially provide intravenous (IV) medicine to help you fall asleep during both procedures.

In an open procedure for acid reflux, the surgeon:

• Cuts your abdomen open in one large incision.
• Wraps the bottom portion of the esophagus with the fundus, the top portion of the stomach.
• Uses staples to seal the incision.

The surgeon does a laparoscopic Nissen fundoplication by:

• Creates four to five tiny abdominal incisions.
• Inserts a tiny instrument called a laparoscope—which has a camera—into your abdomen.
• Wraps the upper stomach around the lower esophagus using the camera images and tiny surgical tools.
• Uses stitches to seal theincision.

After the procedure

Right after the surgery, you might experience a sore throat for a day or two. If open fundoplication was performed, a temporary Nasogastric (NG) tube will be needed to remove digestive juices from the stomach during recovery. An IV line may also be used to provide fluids until you or your child can start eating again. You can resume eating once you have passed gas or had a bowel movement, which indicates that your digestive system is beginning to function normally.

Hospital stays typically last one or more days for both adults and children after the surgery. The length of recovery depends on whether the surgery was laparoscopic or open, as well as any other existing medical conditions. Many patients who undergo laparoscopic surgery are able to go home the following day.

Outcome

Many doctors recommend a soft foods diet for the first seven to ten days following surgery. You can typically return to your regular activities and gentle exercise within a few days after the procedure.

Children can usually go back to school a few days after leaving the hospital. However, they should avoid strenuous activities for at least three weeks. Activity restrictions may vary depending on whether the surgery was open or laparoscopic.