A Nissen fundoplication is a surgical procedure to tighten the lower esophageal sphincter, the valve between the esophagus and the stomach. The operation treats gastroesophageal reflux disease (GERD) by preventing stomach acid from backing up. During the procedure, the upper end of the stomach, known as the fundus, is wrapped around the lower esophagus to strengthen the barrier between the two organs. Performed laparoscopically, the surgery requires only small incisions and results in less scarring and a shorter recovery period than an open procedure. A hiatal hernia can also be repaired during this operation.
Candidates for a Nissen Fundoplication
Patients whose heartburn is not well-controlled by medication, or who are having troubling side effects, may be candidates for this surgery. The procedure may also be recommended for patients experiencing serious complications of GERD, such as:
- Barrett's esophagus
Most patients see an improvement in their symptoms after the procedure and no longer require daily medication. Patients who are elderly, have other health problems, or have weak peristalsis (digestive motion) are not good candidates for a Nissen Fundoplication. In some cases, this surgery may even worsen their condition.
The Nissen Fundoplication Procedure
During a laparoscopic Nissen fundoplication, three to four small incisions are made in the patient's abdomen into which a laparoscope and tiny surgical instruments are inserted. If the patient is obese or has a short esophagus, the operation may alternatively be performed through small incisions in the chest. In either case, the surgeon effects the valve repair with video guidance, watching the action on a computer monitor in real time.
Risks of a Nissen Fundoplication Procedure
A laparoscopic Nissen fundoplication is considered safe for most patients, yet there are certain risks associated with any kind of surgical procedure, such as the possibility of infection or excessive bleeding. In addition, risks of this particular procedure may include:
- Difficulty burping
- Difficulty swallowing
- Increased flatulence
- Dumping syndrome
On occasion, as time passes after the surgery, the esophagus may slip out of the surgical wrapping provided by the stomach and the GERD symptoms may recur.
Recovery From a Nissen Fundoplication Procedure
Patients usually recover quickly and completely from this operation, but have to make some dietary and behavioral adjustments. Immediately after surgery, the patient's diet is restricted to clear fluids. In the coming days, the patient can ingest thicker, more nutritious liquids, then moves on first to soft foods and then to a complete diet.
Patients are advised to eat small meals several times a day and to drink fluids frequently throughout the day. In order to prevent gas, patients should avoid:
- Drinking through straws
- Chewing gum or tobacco
- Eating gas-producing foods like beans
- Eating citrus and tomato products
- Drinking carbonated beverages
After a Nissen Fundoplication procedure, patients are also advised to eat more slowly and to chew their food thoroughly. They are also cautioned not eat before lying down or going to bed.