Nissen Fundoplication

Article Context

1. Overview
2. Procedure
3. Benefits and Risks
4. Care at Medicover
5. Frequently Asked Questions

Overview

Nissen fundoplication is also referred to as a Lap Nissen, GERD surgery or acid reflux surgery. It is a laparoscopic procedure indicated for gastroesophageal reflux disease(GERD). The common symptom of gastroesophageal reflux disease is heartburn. This is a burning sensation felt in the lower portion of the chest. Other symptoms include dysphagia and regurgitation of acids or fluid back into the oesophagus.

Initially, patients with reflux are treated with medications that reduce acid production in the stomach. This will in turn reduce the esophageal damage caused by stomach acid reflux. Despite high doses of medical therapy, patients might have severe symptoms of regurgitation or insufficient healing of oesophagus. These patients are advised to have surgery.

Procedure

Before the Procedure

• The patients require tests, including an upper endoscopy and a barium swallow x-ray. This is necessary to detect any esophageal narrowing as well as any hiatal hernia (top of your stomach bulges into your chest). A hiatal hernia can aggravate reflux disease.
• Other tests include esophageal manometry, which measures the pressures created within the oesophagus as a result of swallowing. This is accomplished by inserting a catheter through the nose and down the oesophagus. The pressure is measured by the catheter at various points within the oesophagus.
• You will be asked to sip water, which causes peristalsis, or muscle movement within the oesophagus. This should continue in a coordinated fashion down the oesophagus, creating enough pressure to allow the water to pass into the stomach.
• Esophageal manometry also investigates pressures in the lower esophageal sphincter. This is an important test because it provides information on both the tone and function of the lower esophageal sphincter. Certain esophageal conditions can mimic reflux disease, but require entirely different treatment.
• Occasionally, a 24 hr pH monitor is performed. A probe is passed down the nose and into the oesophagus, where it remains for 24 hours. This probe counts the number of times acid from the stomach refluxes into the oesophagus. After 24 hours, the probe is removed and analysed to determine how much acid exposure occurs within the oesophagus.

During the Procedure

• The laparoscopic procedure requires the placement of five incisions or ports for the placement of a camera and working surgical instruments. Incisions are placed to allow exposure of the gastroesophageal junction by elevating the liver with a retractor.
• The stomach is then mobilised, exposing the oesophagus. To mobilise the upper part of the stomach known as the fundus, which is then used for the fundoplication, some small vessels are divided between the spleen and the stomach.
• The oesophagus is mobilised, and any scar tissue surrounding it is divided. The hiatal hernia is repaired and returned to its proper location in the abdomen. If there is a large defect, the hiatus (the hole in the diaphragm through which the oesophagus passes) is partially closed.
• The mobilised fundus of the stomach is then wrapped around the lower portion of the oesophagus. The fundoplication is formed by suturing the stomach to the oesophagus.
• The entire procedure takes two to three hours.

After the surgery

• Following surgery, patients stay in the hospital for approximately 2-3 days. You can resume your normal activities within two to three weeks. You should follow dietary restrictions for about two weeks and can start advancing to a normal diet after the hospital visit two weeks after surgery.
• You can now stop taking all of the reflux medications and lie flat in bed, eat late at night, and do other things that you couldn't do before.

Benefits of surgery

Nissen fundoplication has the advantage of shorter hospital stay, few scars which heal faster causing less pain and a lower risk of infections and hernia.

Risks of surgery

Complications can occur from general anaesthesia, bleeding, infection, and injury to nearby organs.

Care at Medicover

At Medicover Hospitals, we have the most eminent team of gastroenterologists who are experienced in providing excellent healthcare services to patients with care and compassion. Our hospital is equipped with advanced technology and equipment to conduct the tests required for the diagnosis of GERD based on which a dedicated treatment plan is designed. Gastroenterologists at Medicover diagnose and treat this condition with utmost precision that brings successful treatment outcomes. The entire treatment process and the post-treatment follow-up schedules are designed to ensure lasting results.

Our Gastroenterologists

Frequently Asked Questions:

1. How does a Nissen fundoplication work?

Nissen fundoplication surgery is used to treat gastroesophageal reflux disease (GERD). A surgeon creates a sphincter at the bottom of the oesophagus to prevent acid reflux. After surgery, most people notice a significant reduction in acid reflux symptoms.

2. What are the alternative procedures of Nissen fundoplication?

Transoral incisionless fundoplication in which stomach and oesophagus are stapled through mouth rather than through abdominal incisions. LINX magnetic sphincter device is another approach in which a magnetic ring encircles the esophageal sphincter. A food bolus separates the components of the magnetic ring and the attraction of ring components after a meal prevents acid reflux.The Stretta procedure uses radiofrequency energy and an endoscope to treat GERD.

3. Does everyone who has abnormal reflux need surgery?

No, most of the people with abnormal reflux can be treated with medications and lifestyle modifications. Only patients with complications and those with severe GERD should consider surgery.

4. Will I need tests to see if I have GERD?

Your doctor may diagnose GERD just by symptoms you report. If your symptoms continue more than 4 weeks despite using medications, you may undergo some tests such as upper endoscopy, barium swallow x-ray, esophageal manometry and 24 hr pH monitoring.

5. What are the complications of fundoplication surgery?

Bleeding at the surgical site, difficulty swallowing, difficulty belching and infection in your abdomen.

6. Can GERD return after fundoplication?

Nissen fundoplication has high success rates when the surgery is performed by an expert gastroenterologist. Therefore, most patients who present with recurrent heartburn after a properly performed Nissen fundoplication do not have GERD.

7. How painful is Nissen fundoplication?

The operation usually causes only mild pain. The abdomen, as well as the small incision sites, will be sore, and some patients will experience shoulder pain for the first day or two. The shoulder pain is caused by gas that was left in your abdomen during the surgery.

8. What are the foods that I should avoid after Nissen fundoplication?

Any foods that cause stomach gas and distention should be avoided. Avoid alcoholic beverages, citrus fruits, and carbonated beverages.

9. What are the advantages of the fundoplication procedure?

The advantages of fundoplication are it reduces symptoms such as heartburn, abdominal pain, vomiting, throat irritation, restores normal function of the reflux barrier, treats GERD and hiatal hernia.

10. What is the cost of the Nissen fundoplication procedure?

The cost of surgery can range between INR 50000 to INR 200000, but it can vary depending on the complexity of the problem and the city in which you are getting treated.

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