Nissen Fundoplication

Nissen Fundoplication is a surgery that helps people with severe gastroesophageal reflux disease (GERD). It strengthens the lower esophageal sphincter. This stops stomach acid from flowing back into the esophagus.

If lifestyle changes and medicine don’t work, Nissen Fundoplication is a good choice. We’ll look at GERD’s causes and symptoms, how the surgery works, and what happens before, during, and after it.

Understanding Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is a long-term digestive problem. It happens when stomach acid or bile flows back into the esophagus. This backflow, called acid reflux, can cause irritation and inflammation.

It can lead to uncomfortable symptoms and serious problems if not treated.

Symptoms of GERD

The most common symptoms of GERD include:

• Heartburn (a burning sensation in the chest)
• Regurgitation of food or sour liquid
• Difficulty swallowing
• Chest pain
• Dry cough or hoarseness
• Sore throat
• Sensation of a lump in the throat

Causes of GERD

Several factors can contribute to GERD, such as:

• Weakened lower esophageal sphincter (LES)
• Hiatal hernia, which occurs when part of the stomach protrudes through the diaphragm
• Obesity
• Pregnancy
• Certain medications (e.g., antihistamines, calcium channel blockers)
• Smoking
• Consuming large meals or lying down after eating

A hiatal hernia is a common problem linked to GERD. It can make the LES weaker, allowing acid reflux to happen more easily.

Complications of Untreated GERD

If GERD is not managed well, it can lead to serious problems, including:

• Esophageal inflammation (esophagitis)
• Esophageal ulcers
• Esophageal strictures (narrowing of the esophagus)
• Barrett’s esophagus (precancerous changes in esophageal lining)
• Increased risk of esophageal cancer

Barrett’s esophagus is a serious issue from long-term acid reflux. It changes the esophageal lining to something like the intestines. People with Barrett’s esophagus need regular checks because they have a higher risk of esophageal cancer.

What is Nissen Fundoplication?

Nissen Fundoplication is a surgery for severe GERD that doesn’t get better with lifestyle changes or medicine. It wraps the stomach’s top around the esophagus’s bottom to stop acid reflux. This esophageal surgery creates a new valve.

This surgery is the top choice for treating GERD. It helps patients feel better and live better lives. It’s done laparoscopically, which means small cuts and special tools. This makes recovery faster than old-school surgery.

How Nissen Fundoplication Works

The surgeon wraps the stomach’s top around the esophagus’s bottom during the surgery. This creates a new valve. The valve stops stomach acid from going back up into the esophagus, fixing GERD.

The surgeon might also fix a hiatal hernia if it’s there. A hiatal hernia happens when stomach bulges through the diaphragm. Fixing it helps the surgery work better.

Indications for Nissen Fundoplication

This surgery is for those with severe GERD who haven’t gotten better with other treatments. It’s for:

• GERD symptoms that won’t go away with medicine
• Esophageal ulcers or Barrett’s esophagus from GERD
• Can’t take acid-suppressing medicine for a long time
• Severe nighttime reflux that disrupts sleep or causes pneumonia
• Large hiatal hernia that makes GERD symptoms worse

Before getting this wrap procedure for GERD, talk to your doctor. They can help decide if it’s right for you.

Preparing for Nissen Fundoplication Surgery

Getting ready for Nissen fundoplication surgery is key to a good outcome. Your healthcare team will help you get ready. They will check your medical history, current meds, and any allergies during the pre-operative evaluation.

When preparing for surgical preparation, you might need to:

Your surgeon will give you all the details on getting ready for surgery. This includes any special diet or lifestyle changes. It’s important to follow these steps closely. This helps avoid complications and makes recovery smoother. Always talk to your healthcare team if you have any worries or questions.

The Nissen Fundoplication Procedure

Nissen fundoplication is a surgery to treat chronic GERD. It strengthens the lower esophageal sphincter (LES). This surgery can be done laparoscopically or openly, depending on the patient and surgeon.

Laparoscopic Approach

Laparoscopic fundoplication is the preferred method. It’s less invasive and leads to quicker recovery. The surgeon makes small incisions and uses a laparoscope and instruments.

They wrap the stomach around the lower esophagus. This creates a new valve to stop acid reflux.

Open Surgery Approach

Open surgery is used in some cases. It involves a larger incision to access the stomach and esophagus. This method is for patients with complex issues or previous surgeries.

Hiatal Hernia Repair During Nissen Fundoplication

Many with GERD also have hiatal hernias. During Nissen fundoplication, the surgeon fixes the hernia. They move the stomach below the diaphragm and tighten the diaphragm opening.

This step improves long-term results and lowers the chance of GERD coming back.

Recovery After Nissen Fundoplication

After Nissen Fundoplication surgery, patients need to follow post-operative care steps. These steps include managing pain, changing their diet, and avoiding certain activities. This recovery time is key for the body to heal and adjust to the surgery.

Pain Management

Patients might feel some pain in their belly after surgery. Managing this pain is very important. Your doctor will give you pain medicines to help. These can be:

Dietary Modifications

After the surgery, you’ll need to follow a special GERD diet. This diet helps your esophagus and stomach heal. You’ll need to:

• Eat small meals often
• Avoid fizzy drinks and acidic foods
• Not eat too much fat or spicy food
• Stay sitting up for 30 minutes after eating

Activity Restrictions

While recovering, you should not do hard work or lift heavy things. Start doing more physical activities slowly, as your doctor advises. You should avoid:

By following your doctor’s care plan, eating right, and slowly getting back to activities, you’ll recover well from Nissen Fundoplication surgery.

Benefits of Nissen Fundoplication

Nissen fundoplication is a surgery that helps those with severe GERD. It strengthens the lower esophageal sphincter. This gives long-lasting GERD symptom relief and boosts quality of life.

Acid Reflux Prevention

This surgery stops acid reflux. It wraps the stomach around the lower esophagus. This makes a strong barrier against stomach acid.

Studies show it can cut acid exposure in the esophagus by 95%. This greatly reduces symptoms like heartburn and chest pain. Patients can enjoy meals and activities without acid reflux worries.

Improvement in Quality of Life

Nissen fundoplication also improves life quality. It helps with sleep, work, and social life. It makes daily life feel normal again.

Patients sleep better, without acid reflux at night. They also have more energy and focus at work. This surgery lets them enjoy life more.

Risks and Complications of Nissen Fundoplication

Nissen fundoplication is a safe and effective way to treat GERD. But, it’s key to know the possible risks and complications. Patients should talk to their surgeon about these before the surgery.

Some risks and complications include:

Other rare complications could be damage to nearby organs or breathing problems from anesthesia. Even though serious problems are rare, it’s important to know about them. Patients should tell their doctor right away if they notice any unusual symptoms.

Choosing an experienced surgeon and following instructions can lower the risk of complications. Most people find the benefits of Nissen fundoplication, like better quality of life and less GERD symptoms, worth the risks.

Alternatives to Nissen Fundoplication

Nissen fundoplication is a top choice for treating severe GERD. Yet, it’s not the only option. Some might look into other treatments first, like medications or endoscopic therapies.

Medication Management

Many with GERD find relief with medications. Common ones include:

Proton pump inhibitors are often the first choice for GERD. They work well to cut down stomach acid. But, using them for a long time can lead to nutrient deficiencies and infections.

Other Anti-Reflux Surgical Procedures

There are other surgeries for GERD too:

• Toupet fundoplication: A partial wrap around the lower esophagus, which may have fewer side effects than Nissen fundoplication
• Linx reflux management system: A small, flexible band of magnetic beads placed around the lower esophageal sphincter to prevent reflux
• Endoscopic therapies: Minimally invasive procedures performed through an endoscope, such as Stretta or TIF (Transoral Incisionless Fundoplication)

The right surgery depends on many things. This includes how bad GERD symptoms are, if there’s a hiatal hernia, and the patient’s health. Talking to a surgeon can help find the best treatment.

Long-Term Outcomes of Nissen Fundoplication

Nissen fundoplication is a lasting fix for severe GERD. It strengthens the lower esophageal sphincter and stops acid reflux. This surgery brings long-term relief and boosts life quality.

Success Rates

Many studies show Nissen fundoplication’s success in managing GERD. Long-term data shows high success rates:

These figures show Nissen fundoplication’s lasting effectiveness. Most patients see a big drop in reflux symptoms. They often need less or no medication for acid reflux.

Recurrence of GERD Symptoms

Even though Nissen fundoplication works well, some patients might see GERD symptoms again. Reasons for this include:

• Loosening of the fundoplication wrap
• Development of a hiatal hernia
• Weight gain
• Persistent esophageal motility disorders

If symptoms come back, doctors might suggest other treatments. This could be medication or another surgery. But, the need for more surgery is rare, happening in 5-10% of cases over time.

Choosing a Surgeon for Nissen Fundoplication

Choosing the right surgeon for Nissen Fundoplication surgery is key for the best results. Look for a surgeon with lots of experience and training in this procedure. They should have a good success rate and know both laparoscopic and open surgery well.

Good communication with your surgeon is also important. They should explain the surgery clearly, talk about your case, and answer all your questions. You should feel at ease and trust them to do the surgery.

Also, think about the hospital where the surgery will happen. A well-known hospital with skilled staff and modern technology can help your surgery and recovery go smoothly. Ask your doctor for recommendations and check the surgeon’s credentials and patient feedback before deciding.