Nissen
Fundoplication Procedure
What is Gastroesophageal Reflux?
Gastroesophageal reflux, acid reflux or heartburn
occurs when secretions from the stomach back up or reflux into the
esophagus (the tube that connects the mouth to the stomach). The
secretions typically have a high concentration of acid and act by
irritating and inflaming the esophagus. Typically it causes a harsh,
burning sensation in the chest or upper abdomen, and can radiate
throughout the chest or up to the throat. It may lead to other symptoms
such as difficulty swallowing, chronic coughing, sour taste, bad
breath, vomiting, wheezing and erosion of tooth enamel. Over time,
these secretions can cause permanent damage to the esophagus and
lead to narrowing or stricture of the esophagus, ulcerations, metaplastic
changes (Barrett’s esophagus), and even esophageal cancer.
How is Gastroesophageal Reflux
treated?
There are progressive
steps in the treatment of Gastroesophageal reflux
- Gastroesophageal reflux may be reduced by
making changes in habits or diet. Weight loss, smoking cessation,
reducing alcohol consumption, lowering anxiety or stress, dietary
modifications and changing sleep habits can help decrease the
symptoms.
- Medications such as antacids can help neutralize
stomach acid or block the secretion of stomach acid. These can
be obtained from your doctor.
- The Nissen fundoplication anti-reflux surgery
procedure is an option that alleviates chronic heartburn where
the patients condition cannot be controlled by medication or other
means.
Gastroesophageal
reflux
What is the Nissen Fundoplication
Procedure?
Nissen fundoplication is a procedure for strengthening
the valve muscle between the stomach and the esophagus preventing
stomach acids from being forced back up into the esophagus.
Normally, a circular band of muscle called the lower esophageal
sphincter acts like a one-way valve and only opens when swallowing.
The lower esophageal sphincter should otherwise remain closed and
prevent the back up of any stomach secretions into the esophagus.
If the lower esophageal sphincter becomes weakened or abnormally
relaxes, the stomach secretions can reflux up and cause the associated
symptoms. These changes in the lower esophageal sphincter can also
be exacerbated by the presence of a hiatal hernia. This occurs when
a portion of the stomach protrudes through the diaphragm and goes
up into the chest.
The Nissen fundoplication proceedure offers a good chance of correcting
this condition. A recent study found that 90 percent of patients
undergoing the procedure are symptom-free after 10 years.
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Advantages of the Laparoscopic
Nissen Procedure
First performed by Dr. Rudolph Nissen in 1951, Nissen
fundoplication is performed laparoscopically with three small incisions,
patients experience minimal pain and fast recovery, patients can
return to work within two weeks.
To prevent stomach acids from being forced back into the esophagus,
The surgeon must strengthen the "valve" between the stomach
and the esophagus. This is achieved by folding a part of the upper
portion of the stomach, or fundus, around the bottom of the esophagus
strengthening the Stomach Valve.
Patients often have hiatal hernias, contributing
to the condition causing a burning sensation that in the chest and
throat. Although this condition alone cannot cause gastroesophageal
reflux, The surgeon repairs the hernia.
In a small percentage of cases-about one in 50 (about 2 %) the surgeon
is unable to complete the Nissen fundoplication laparoscopically,
and must revert to an open procedure.
Before Surgery
Not all patients with heartburn need or can benefit
from Nissen fundoplication. The surgeon will carefully evaluate
your condition and discuss the benefits, risks, and possible complications
of the operation.
The Typical Program
- Day 1 - Arrival and MRSA Test
- Day 2 - Consultation and clinical checks
- Day 3 - Surgery
- Day 4 - Stay in hospital
- Day 5 - Post operative check and departure
Because laparoscopic Nissen fundoplication is performed
under general anesthesia, you cannot eat or drink anything after
midnight the day before the surgery.
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Recovering after the procedure
In the hours following the operation, you will experience
some pain from the small incisions your surgeon made to perform
the procedure. After three or four days, you can expect to return
home, where you will be able to take care of yourself.
Within a week or so of leaving the hospital, you can resume your
normal schedule, including returning to work. After a few weeks
you can also resume fitness programs and sports competition.
The surgical incisions will be barely visible
a few months after the procedure.
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