What is laparoscopic Nissen fundoplication?
Laparoscopic Nissen fundoplication is a minimally invasive procedure to treat severe gastroesophageal reflux disease (GERD). Laparoscopic Nissen fundoplication helps to strengthen the lower esophageal sphincter muscle by reducing the potential for stomach acid to move back up into the esophagus. In a Nissen fundoplication the top part of the stomach (fundus) is wrapped 360 degrees around the lower esophagus and sutured.
Nissen fundoplication is named after Dr. Rudolf Nissen, who first designed the procedure in the 1950s, as a treatment for severe reflux esophagitis (inflammation of the esophagus). It is now a common treatment for severe GERD and often accompanied by a repair of hiatal hernia, which is common in GERD patients.
Why is laparoscopic Nissen fundoplication performed?
GERD is a condition in which the stomach acid flows backward up into the esophagus, irritating the lining and causing symptoms such as
- Chest pain
- Burning at the back of the throat
- Acidic taste in the mouth
- Chronic hoarseness, cough and sore throat
GERD is caused by dysfunction of the lower esophageal sphincter muscle. In a healthy person, this muscle acts as a valve that opens to let food pass into the stomach and closes to prevent the stomach contents coming back into the esophagus.
Laparoscopic Nissen fundoplication is performed to strengthen the sphincter muscle to prevent acid reflux. The procedure is performed in situations such as:
- Medications, diet and lifestyle changes do not provide relief
- Requirement of long-term treatment with medications
- Complications from GERD such as
- Barrett’s esophagus (abnormal cells in the esophagus)
- Peptic stricture (narrowing of esophagus)
- Development of GERD-associated hoarseness, cough or asthma
- Development of hiatal hernia
- Chronic esophagitis
How is a laparoscopic Nissen fundoplication performed?
Nissen fundoplication is a commonly performed laparoscopic surgery. The surgeon performs the procedure using tiny surgical instruments inserted through a flexible tube (laparoscope). Surgeons access the stomach through five tiny incisions made in the upper abdominal region. The surgeon is guided by images transmitted from a lighted camera in the laparoscope inserted through one of the incisions.
Laparoscopic Nissen fundoplication is performed under general anesthesia in an operation room. The procedure may take up to three hours.
Prior to the procedure a patient may be required to
- Undergo physical examination, blood, urine and imaging tests
- Undergo esophagogastroduodenoscopy test to examine the upper gastrointestinal tract, along with a biopsy
- Undergo esophageal manometry test to test the muscular function of the esophagus
- Undergo impedance monitoring test to evaluate the movement of food down the esophagus
- Undergo a gastric emptying study
- Undergo 24-hour monitoring for pH value (acidity) assessment
- Drink only clear liquids for 24-48 hours before the procedure, according to the doctor’s advice.
- Avoid eating or drinking anything for eight hours prior
- Check with the doctor before taking any regular medications
- Inform the doctor of any allergies
- An anesthesiologist administers anesthesia and monitors the patient’s vital functions during the procedure.
- The patient will be intubated to assist breathing.
- The patient will have an IV line for medication.
- The surgeon makes five tiny incisions in the upper abdominal area.
- The surgeon inflates the abdomen with carbon dioxide for improved visibility.
- Using tiny instruments inserted through the incisions, the surgeon grasps the fundus portion of the stomach.
- The surgeon then wraps the fundus over the lower esophageal sphincter and sutures it.
- If a hiatal hernia is present, the surgeon repairs the hernia.
- The surgeon arrests any bleeding present and lets the gas out.
- The instruments are removed, and the incisions are closed with dissolvable sutures.
- The patient is brought out of anesthesia, administered painkillers and monitored in the recovery room for a few hours.
How long does it take to recover from a fundoplication?
A laparoscopic Nissen fundoplication may require hospital stay of two days. Most people are able to resume normal activities after two or three weeks. The patient may have to be on a soft food or liquid diet until the esophagus heals, and avoid heavy lifting and strenuous activities.
How long does a laparoscopic Nissen fundoplication last?
For a majority of patients, laparoscopic Nissen fundoplication is reported to have resulted in lasting relief. The procedure improves quality of life and is superior to being on lifelong medication. A small percentage of people may have persisting symptoms. Some may have to repeat the surgery due to complications from the fundoplication or other underlying conditions.
What are the risks and complications of a laparoscopic Nissen fundoplication?
Laparoscopic Nissen fundoplication is a surgical solution for serious GERD, but there are a few risks associated with the procedure, which include:
Side effects of anesthesia such as
Risks of surgery such as
- wound infection
- blood clots
- damage to internal organs, blood vessels or nerves
- Pain and/or difficulty with swallowing (dysphagia)
- Stomach fullness or discomfort after eating
- Gas and bloating
- Collapse of lung (pneumothorax)
- Infection and sepsis
- Late complications
- Persistent gas and bloating
- Persistent dysphagia
- Lack of relief from GERD symptoms
- Scar formation leading to adhesions
- Incisional hernia
- Requirement of redo procedures due to complications
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