Introduction
GERD (gastroesophageal reflux disease) is a common illness and has a great impact on an individual's health. GERD is a serious disease condition; if necessary treatment is not provided at the time, this may damage the lining of the food pipe and lead to severe inflammation and pain. It occurs when the gastric contents reflux in the esophagus and thus resulting in severe trauma, irritation, and inflammation of the tissue. GERD presents with symptoms like regurgitation, heartburn, chest pain, dysphagia, nausea, vomiting, bloating, and abdominal pain. Other symptoms like pulmonary sequelae, hoarseness, cough, and laryngotracheal stenosis are also exhibited. There are two approaches to managing GERD, medical intervention and surgical. Fundoplication is the most commonly used anti-reflux surgery.
What Is a Nissen Fundoplication?
Nissen Fundoplication is a corrective surgery done to treat GERD. Here, the procedure is done to tighten the junction between the stomach and esophagus, which will prevent acid reflux.
What Are the Types of Nissen Fundoplication?
There are two types of Nissen Fundoplication provided by the healthcare provider:
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Laparoscopic: In this procedure, tiny incisions are made, and laparoscopic devices with camera heads are inserted into the body to have a clear view of the organs inside the body.
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Open Surgery: In this procedure, large incisions are made to access the organ inside, and large instruments and more range of motion techniques are used to perform this type of surgery.
Other types in detail are:
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Nissen 360-degree Wrap- In this technique, the fundus is wrapped around the bottom of the esophagus to tighten the sphincter. This prevents vomiting and burping and can make GERD worse.
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Toupet 270-degree Posterior Wrap- In this technique, the fundus is wrapped two-thirds of the way around the backside, posterior to the bottom of the esophagus. This technique creates more space and releases gas through vomit and burps when necessary.
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Watson Anterior 180-degree Wrap- In this technique, the part of the esophagus next to the diaphragm is reconstructed andwrapped halfway around the front, anterior, and bottom of the esophagus and attached to part of the diaphragm tissue.
What Are the Indications for Nissen Fundoplication?
For an individual to receive a Nissen fundoplication, preoperative testing is done, which selects the appropriate candidate for the surgery. These tests are:
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Esophagogastroduodenoscopy: This is done for the assessment of inflammation of the esophagus and also the gastroesophageal junction flap.
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Ambulatory pH monitoring: Ideal for diagnosis of GERD. It is used to diagnose unless prior esophagogastroduodenoscopy shows peptic strictures for GERD.
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Esophageal Manometry: This procedure uses a preoperative evaluation of the junction anatomy of the esophagus. It also checks for the presence of a hiatal hernia and the length of the esophagus intra-abdominally.
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Barium Esophagram: Used in the detection of esophageal motility disorders and measuring LES (lower esophageal sphincter) resting pressure.
After the test, the individuals who have severe symptoms of GERD along with one of the following are clearly indicated for Nissen Fundoplication:
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Failed maximal medical therapy.
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Unable to take medications due to compliance or side effects.
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Barrett's Esophagus.
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Younger individuals who do not take chronic medications are in the interest of adverse effects and long-term costs.
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Repeated aspiration pneumonia or asthma related to reflux.
What Happens During and After the Procedure of Nissen Fundoplication?
During the surgery, either an open approach or the laparoscopic way, anesthesia is first given IV (intravenous) prior to the surgery.
Open Approach:
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Over the abdomen, a large incision is made, which wraps the upper part of the fundus (stomach) and covers the lower part of the esophagus. Later to this, the incision is closed and stapled.
Laparoscopic Approach:
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Around four to five incisions are made in the abdomen, and a laparoscopic instrument is inserted, along with other tiny operating tools.
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These tools wrap the fundus around the esophagus, and then the incision is closed with stitches.
After the procedure, one may feel a sore throat. Some cases require an IV line to deliver fluids until you start to eat again. One can resume eating once they pass gas and bowel. These indicate the body is getting back to the usual process. Adults and children may have to spend more days in hospitalization after the procedure. Recovery depends on the approach taken for the procedure. Mostly laparoscopic approach individuals recover faster than open-approach surgery. For the first seven to ten days after the procedure many surgeons recommend a soft food diet. The individual can usually return to usual activities and light exercise within a few days of surgery. One should avoid strenuous activity for a minimum of three weeks. Restrictions can vary depending on the type of surgery and vary between open procedure and laparoscopic approach.
What Are the Advantages of the Procedure Nissen Fundoplication?
The main advantage of Nissen fundoplication is improvement in symptoms of gastroesophageal acid reflux disease. These relieving symptoms keep individuals more comfortable and reduce the chance of developing Barrett’s esophagus, which is responsible for raising the risk of getting esophageal cancer. One who receives a laparoscopic approach of Nissen fundoplication gets benefits like less pain, shorter hospital stay, and faster recovery.
What Are the Complications and Risks Associated With Nissen Fundoplication?
The main and biggest complication of Nissen fundoplication is symptom relief which is achieved after the procedure does not last long. In most cases, the individual requires another surgery within a span of two to three years. Along with it, like all other surgeries, this procedure also carries the risk of infection at the incision site. Sometimes after the procedure, one may notice signs like excessive swelling, bleeding, fever, vomiting, and flushed or hot skin around the incision site. The doctor should be contacted immediately if one notices these signs.
Also, lung infections, like pneumonia and dumping syndrome are potential complications of the surgery.
Conclusion
Individuals with gastroesophageal reflux disease are the main candidates for whom Nissen fundoplication is performed. This is one of the procedures to restore the anatomy of the lower esophageal sphincter. The laparoscopic approach results in minimal mortality and morbidity. Research and studies are under process for other therapies like magnetic sphincter augmentation devices and transoral incisionless fundoplication. Complete and partial wraps are the most commonly performed surgery as a treatment for GERD. Novel therapies have shown more promising short-term results.
