Introduction
A nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernias.
In GERD it is usually preformed when medical therapy has failed. Fundoplication surgery is the most common surgery used to treat GERD. This surgery strengthens the valve between the esophagus and the stomach to keep acid from backing up into the esophagus as easily. It relieves GERD symptoms and inflammation of the esophagus, allowing the esophagus to heal.
It is the first-line procedure with a hiatal hernia. A hiatal hernia occurs when a small portion of the stomach pushes upward through the diaphragm, a sheet like muscle that separates the lungs from the abdomen. Usually this doesn’t cause any symptoms, but it increases the risk of stomach acid backing up into the esophagus (reflux), which can lead to heartburn. Normally the entire stomach sits below the diaphragm. The esophagus passes through an opening in the diaphragm called the hiatus before it enters the stomach. Weakened tissues within and around the hiatus allow a hiatal hernia to develop.
Indications
- Recurrent esophagitis
- Barrett’s esophagitis
- Persistent reflux symptoms
- Hiatal hernia
Procedure
In a fundoplication, the gastric fundus (upper part) of the stomach is wrapped around the lower end of the esophagus and stitched in place so that the lower portion of the esophagus passes through a small tunnel of stomach muscle. This reinforces the closing function of the lower esophageal sphincter. This procedure can be done through the abdomen or the chest. The chest approach is often used if the patient is overweight or has a short esophagus. If a person has a hiatal hernia, which can cause gatroesophageal reflux disease symptoms, it will also be repaired during this surgery.
What to expect after surgery
If open surgery is done, you will most likely spend several days in the hospital and need 4-6 weeks to get back to your normal routine. If the laparoscopic method is used, your hospital stay is usually 2-3 days and it takes 2-3 weeks to resume your normal activity. After either surgery, you may need to change your diet, eating only soft foods until you are healed. You should chew thoroughly and eat more slowly to give the food time to go down the esophagus.
Risks
- Difficulty swallowing
- The wrap slipping
- Heartburn
- Bloating caused by gas build up
- Excess gas