Laparoscopic hiatal hernia repair with nissen fundoplication

What is a laparoscopic Nissen fundoplication?

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Laparoscopic Nissen fundoplication is currently the ‘gold-standard’ for treating GERD in patients who don’t respond completely to medications or can’t take medications for another reason. Laparoscopic Nissen fundoplication is the most commonly performed antireflux procedure. Laparoscopic procedures are performed through very small incisions while the surgeon watches on a video monitor. During surgery, the top of the stomach (the fundus – hence the term fundoplication) is wrapped around the bottom of the esophagus. Another term for the fundoplication is a ‘wrap’. This essentially repairs the valve at the end of the esophagus that doesn’t work properly in patients with GERD. As opposed to medications for GERD, surgery stops all reflux – digestive enzymes AND acid. Because of this, surgery can cure reflux like medications can’t. If a hiatal hernia is present, this is fixed at the same time as the Nissen fundoplication.

What are the results of laparoscopic Nissen fundoplication?

When performed by an experienced surgeon, the results of GERD surgery are excellent.

Living with poorly controlled GERD symptoms can affect a patient’s quality of life. Studies show that quality of life is significantly improved after surgery for GERD
GERD-related symptoms reliably resolve in a high percentage of patients after surgery
Most patients are able to stop taking acid-suppression medications
Most patients are satisfied with the results of surgery (>90%)
Most patients are discharged from the hospital on the morning after their surgery and return to a normal lifestyle in 2-4 weeks

What are the possible complications of laparoscopic Nissen fundoplication surgery?

Serious complications after laparoscopic antireflux surgery are rare. For an in-depth discussion of the risks, options, and alternatives to laparoscopic Nissen fundoplication, please make an appointment with a surgeon.

Are there any side effects?

Side effects can occur, but in most cases these wane with time. Abdominal bloating can occur after fundoplication, but is rarely severe. Difficulty swallowing (dysphagia) is another side effect that tends to improve in most patients with time – provided food is chewed thoroughly. The majority of patients are able to belch easily when necessary; especially once some time has passed following surgery.

Overview

What is a Nissen fundoplication?

A Nissen fundoplication is a surgery to correct gastroesophageal reflux disease (GERD). The surgery tightens the junction between the esophagus and the stomach to prevent acid reflux.

The esophagus is the tube between your mouth and stomach. It is part of your gastrointestinal (GI) system.

What is GERD?

GERD (chronic acid reflux) is a digestive system disorder that affects the esophagus. If you have GERD, your stomach acid and contents persistently flow back up through your esophagus.

What are the types of Nissen fundoplication?

Surgeons perform two types of Nissen fundoplication surgery:

Laparoscopic procedures use tiny incisions (cuts) and cameras to view inside the body.
Open procedures use larger incisions so the surgeon can access inside the body with larger instruments and more range of motion.

Who needs to have a Nissen fundoplication?

Sometimes, you can find relief from acid reflux symptoms with medication or lifestyle changes. If symptoms continue after trying noninvasive treatments, your healthcare provider may recommend Nissen fundoplication surgery. Both children and adults can be candidates for Nissen fundoplication.

Procedure Details

What happens before a Nissen fundoplication?

Before Nissen fundoplication surgery, your surgeon may order tests to examine your stomach and esophagus.

GI X-rays (barium swallow X-rays) take images of your esophagus, stomach and small intestine.
Esophageal manometry measures the pressure in your esophagus when you swallow.
Upper endoscopy examines the upper part of your stomach.
A pH probe to look for evidence of acid in the esophagus.

Healthcare providers use these tests to assess any narrowing in your esophagus. They may also order these tests to look for a hiatal hernia. In this condition, the top of the stomach bulges into the esophagus. Hiatal hernias can worsen GERD symptoms.

How do I prepare for a Nissen fundoplication?

Your healthcare provider will instruct you or your child not to eat or drink anything after midnight the evening before surgery.

What happens during a Nissen fundoplication?

What happens during your surgery varies slightly depending on whether your surgeon uses an open or a laparoscopic approach. In both procedures, an anesthesiologist first gives you intravenous (IV) medication so you fall asleep.

During open acid reflux surgery, the surgeon:

Makes one large incision in your abdomen.
Wraps the upper part of the stomach (fundus) around the lower part of the esophagus.
Closes the incision with staples.

During laparoscopic Nissen fundoplication, the surgeon:

Makes four to five small incisions in your abdomen.
Inserts a laparoscope (small tool with a camera) into your abdomen.
Uses the camera images and tiny operating tools to wrap the upper stomach around the lower esophagus.
Closes the incision with stitches.

What happens after a Nissen fundoplication?

Immediately after surgery, your throat might be sore for a day or two. If you or your child had open fundoplication surgery, you will need a temporary nasogastric (NG) tube. The tube clears the stomach of digestive juices while you heal.

You or your child may also need an IV (intravenous) line to deliver fluids until you can eat again. You’ll be able to resume eating once you have passed gas or had a bowel movement. Those actions are signs that your body is getting back to its usual function.

Adults or children may spend one or more days in the hospital after surgery. Recovery depends on whether the surgeon used a laparoscopic or open approach, as well as if other medical problems exist. Many patients who have laparoscopic surgery can go home the next day.

Risks / Benefits

What are the advantages of a Nissen fundoplication?

Most people notice an improvement in acid reflux symptoms after a Nissen fundoplication. Relieving GERD keeps you more comfortable and reduces the chance of developing Barrett’s esophagus. Barrett’s esophagus raises the risk of esophageal cancer.

People who have laparoscopic Nissen fundoplication also benefit from:

Faster recovery.
Less pain.
Shorter hospital stay.

What are the risks or complications of a Nissen fundoplication?

The primary risk of Nissen fundoplication surgery is that symptom relief does not always last. Some patients need another surgery after two to three years. Like all surgeries, Nissen fundoplication also carries a risk of infection at the incision site.

Recovery and Outlook

What is the recovery time after a Nissen fundoplication?

For the first seven to 10 days after surgery, many surgeons will recommend a soft foods diet. Usually, you can return to usual activities and light exercise within a few days of surgery.

Children can usually go back to school within a few days after going home from the hospital. They should avoid strenuous activity for at least three weeks. Restrictions on activity can vary between laparoscopic and open procedures.

When to Call the Doctor

When should I see my healthcare provider?

If acid reflux symptoms return after surgery, speak with your healthcare provider.

After surgery, you may also notice some swelling around your incision. Call your healthcare provider if you experience:

Bleeding.
Excessive swelling.
Fever.
Flushed or hot skin around the incision.
Vomiting.

A note from Cleveland Clinic

Nissen fundoplication is a surgery to treat GERD. If you have acid reflux that has not responded to medication or other noninvasive treatment, your healthcare provider may recommend surgery. Often, surgeons use a laparoscopic approach to Nissen fundoplication. Laparoscopic surgery uses smaller incisions and results in a quicker recovery. Most people who get a Nissen fundoplication experience a decrease in GERD symptoms.

How long does it take to recover from Nissen fundoplication surgery?

Recovery and Outlook Usually, you can return to usual activities and light exercise within a few days of surgery. Children can usually go back to school within a few days after going home from the hospital. They should avoid strenuous activity for at least three weeks.

How long does laparoscopic Nissen fundoplication surgery take?

The operation is performed under a general anaesthetic and usually takes 1 to 2 hours. Your surgeon will use laparoscopic (keyhole) surgery as this is associated with less pain, less scarring and a faster return to normal activities.

How painful is Nissen fundoplication?

Pain. There is usually minimal pain associated with this operation. The abdomen will be sore as well as the small incision sites, and some patients have shoulder pain for the first day or two. The shoulder pain is caused by gas left in your abdomen during the operation.