Nissen fundoplication
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.
Nissen fundoplication 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.
