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Nissen Fundoplication

Nissen Fundoplication surgery is a procedure to treat gastroesophageal reflux disease (GERD). GERD occurs when stomach contents reflux and enter the lower end of the esophagus (LES) due to a relaxed or weakened sphincter. GERD is treatable disease and serious complications may occur if left untreated.

GERD is treatable disease and serious complications may occur if left untreated. GERD is a chronic condition where the stomach contents reflux into the esophagus. Normally, the stomach contents do not enter the esophagus (food pipe) due to a constricted lower oesophageal sphincter. In GERD, the LES is weak or relaxed enabling stomach acids to reflux into the esophagus.

The Nissen fundoplication (fundo) is a surgical technique that strengthens the sphincter (LES). When performing a fundoplication, the part of the stomach that is closest to the entry of the esophagus (the fundus of the stomach) is gathered, and wrapped around the lower end of the esophagus and oesophageal sphincter, where it is then sutured (sewn) into place. This surgery may be performed through a large, open abdominal incision or endoscopically, through 5 smaller incisions.

Surgical Procedure

Nissen Fundoplication is performed as day surgery either in the hospital or outpatient surgery centers usually with the patient under general anesthesia.

The surgeon uses a needle to inject a harmless gas into the abdominal cavity near the belly button to expand the viewing area of the abdomen giving the surgeon a clear view and room to work. The surgeon makes a small incision in the upper abdomen and inserts a tube called a trocar through which the laparoscope is introduced into the abdomen. Additional small incisions may be made for a variety of surgical instruments to be used during the procedure.

With the images from the laparoscope as a guide, your surgeon wraps the upper part of the stomach, the fundus, around the lower esophagus to create a valve, suturing it in place.

The hole in the diaphragm through which the esophagus passes is then tightened with sutures.

The laparoscope and other instruments are removed and the gas released.

The tiny incisions are closed and covered with small bandages.

Laparoscopy is much less traumatic to the muscles and soft tissues than the traditional method of surgically opening the abdomen with long incisions (open techniques).

Post-Operative Guidelines

After surgery, your surgeon will give you guidelines to follow. Common post-operative guidelines following laparoscopy include the following:

  • You will need someone to drive you home after you are released as the anesthesia may make you feel groggy and tired.
  • Do not remove the dressings over the incisions for the first two days and keep the area clean and dry. No showering or bathing during this time. The incisions usually heal in about 5 days.
  • Your surgeon may give you diet and activity restrictions. It is very important that you follow your surgeon’s instructions for a successful recovery.
  • You may feel soreness around the incision areas. Your surgeon may give you a prescription pain medicine or recommend NSAID’s (non-steroidal anti-inflammatory drugs) for the first few days to keep you comfortable.
  • If the abdomen was distended with gas, you may experience discomfort in the abdomen, chest, or shoulder area for a couple days while the excess gas is being absorbed.
  • Contact your doctor immediately if you have a fever, chills, increased pain, bleeding or fluid leakage from the incisions, chest pain, and shortness of breath, leg pain, or dizziness.

Risks and Complications

As with any surgery there are potential risks involved.  Specific complications for Nissen Fundoplication include:

  • Post-operative fever and infection
  • Surgical injury to blood vessels
  • Surgical injury to stomach or esophagus
  • Swallowing difficulties
  • Gas embolism
  • Adhesions – Extensive scar tissue formation can form in the surgical area.
  • Repeat Surgery – Sometimes the new valve weakens or loosens months or years after the surgery causing symptoms again. If symptoms are severe, the surgery may need to be repeated.