Named after Dr. Rudolph Nissen, the Nissen fundoplication is a surgical treatment option for chronic gastroesophageal reflux disease (GERD). For those patients who have failed the more moderate forms of treatment such as diet and lifestyle modification or medication for GERD, Nissen fundoplication is a viable alternative. It allows most patients to return to normal activities within one to two weeks.
Gastroesophageal Reflux
There is a valve-like structure at the bottom of the esophagus called the lower esophageal sphincter (LES). Its job is to close tightly once food has passed through the esophagus into the stomach, keeping stomach acids and other contents from washing back into the esophagus. When the LES does not do its job, gastroesophageal reflux can occur. Heartburn is a symptom of this. According to the University of Maryland Medical Center, ongoing or chronic gastroesophageal reflux can lead to esophageal ulcers and bleeding, as well as narrowing or stricture of the esophagus.
Before Fundoplication
The website MayoClinic.com advises that your gastroenterologist or surgeon will likely recommend several tests before proceeding with surgery. These include endoscopy, x-rays, esophageal pH monitoring and manometry (a measure of pressure in the esophagus). If deemed appropriate according to the results of these studies, the risks versus benefits of fundoplication are also considered. MayoClinic.com notes 2 to 4 percent of patients suffer surgical complications. The death rate is one in 500 with the laparoscopic procedure. Your physician will help you decide if your risks outweigh the benefits of Nissen fundoplication.
Laparoscopic Fundoplication
In a Nissen fundoplication, the surgeon wraps (plicates) the fundus or upper part of the stomach around the lower part of the esophagus, helping to strengthen the LES. The more traditional "open surgery" requires a large surgical incision. In the laparoscopic procedure, five small incisions suffice, each usually less than one centimeter in size. The surgeon inserts a fiberoptic laparoscope through one of these small incisions, which relays video to a screen. The remaining four incisions are for the small surgical tools necessary to complete the procedure. The surgeon inserts the instruments through the incisions and completes the operation by viewing images on the screen. The less invasive nature of this laparoscopic procedure means fewer stitches, shorter healing time and overall less risk of complications like infection.
After Surgery
MayoClinic.com reports that 90 percent of patients who have the laparoscopic procedure are able to leave the hospital the next day. In addition, 96 percent of patients indicate ongoing satisfaction with the surgery one year later. The University of Pittsburgh Medical Center recommends patients follow a clear liquid diet for a short period before advancing to a full liquid diet and then a soft diet. After that, a patient may require a meal plan that helps avoid diarrhea, excess gas and swallowing problems.
Success Rate
According to MayoClinic.com, those patients who have the more familiar symptoms of GERD, such as heartburn and regurgitation, enjoy a success rate of 90 to 95 percent with the laparoscopic procedure. Less typical symptoms of gastroesophageal reflux are coughing and hoarseness. Unfortunately, patients with these symptoms have a lower success rate of only 70 to 80 percent.
