Nissen Fundoplication Surgery - An Overview

What Is Nissen Fundoplication Surgery?

Nissen fundoplication (NF) is a surgery done to treat GERD. In this procedure, the doctor tightens the area between the stomach and the esophagus (food pipe). This helps prevent the acid from flowing back into the food pipe.

What Are the Types of Nissen Fundoplication Surgery?

This includes Nissen fundoplication and other related techniques.

• Nissen 360-degree wrap

In this technique, the fundus (the upper part of the stomach) is wrapped around the lower part of the esophagus. Doing this helps tighten the sphincter. This further helps prevent vomiting and belching. Among some of them, this can worsen reflux symptoms.

Other types of fundoplication surgeries:

• Toupet 270-degree posterior wrap

In this technique, the fundus is wrapped only two-thirds around the backside of the lower part of the esophagus. This tightens the valve to reduce the reflux, but still allows the gas to release. This can enable the person to burp or vomit if needed.

• Watson anterior 180-degree wrap

In this technique, the upper part of the stomach is wrapped halfway around the front side of the lower food pipe. The surgeon strengthens the area where the food pipe is attached to the diaphragm.

What Happens Before Nissen Fundoplication Surgery?

Before starting the NF procedure, the doctor may recommend some tests to examine the stomach and the esophagus, such as:

• Gastrointestinal (GI) X-ray:

This type of X-ray helps to get images of the esophagus, small intestine, and stomach.

• Esophageal manometry:

Esophageal manometry helps to measure the pressure present in the esophagus when the person swallows.

• Upper endoscopy:

This test helps to examine the upper portion of the stomach.

• Esophageal pH test:

A pH probe will be used to examine the presence of acid in the esophagus.

What Happens During the Procedure of Nissen Fundoplication?

Before any type of surgery (either laparoscopic or open), anesthesia is first given intravenously (IV). After this, NF is done. NF is done in two approaches. These include:

Open approach:

• In this approach, a large incision is made on the abdomen. The upper part of the stomach is wrapped around the lower part of the esophagus. After this, the incision is closed and stapled.

Laparoscopic approach:

• Around four to five incisions are made in the abdomen, and a laparoscopic instrument is inserted, along with other tiny operating tools.

• These tools wrap the fundus around the esophagus, and then the incision is closed with stitches.

What Happens After the Nissen Fundoplication?

After NF surgery, patients typically stay in the hospital for two to three days.

• After the procedure, one may feel a sore throat. Some cases require an IV (intravenous) line to deliver fluids until you are able to start eating again.

• One can resume eating once they have passed gas and had bowel movements. These indicate that the body is returning to its usual process.

• Adults and children may have to spend more days in the hospital after the procedure.

• Recovery depends on the approach taken in the procedure. Mostly, those who underwent the laparoscopic approach recover faster than those in 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 their usual activities and engage in light exercise within a few days of surgery. One should avoid strenuous activity for at least three weeks.

• Restrictions can vary depending on the type of surgery and may differ between open procedures and laparoscopic approaches.

What Are the Indications for Nissen Fundoplication?

For an individual to receive an NF, preoperative testing is conducted to select the appropriate candidate for surgery. After the test, individuals who have severe symptoms of GERD along with one of the following are clearly indicated for NF:

• Failed maximal medical therapy.

• Unable to take medications due to compliance or side effects.

• Barrett's esophagus.

• Younger individuals who do not take chronic medications are at risk of adverse effects and long-term costs.

• Repeated aspiration pneumonia or asthma related to reflux.

What Are the Advantages of the Nissen Fundoplication Procedure?

The main advantage of Nissen fundoplication is improvement in symptoms of gastroesophageal acid reflux disease.

• Nissen fundoplication surgery relieves GERD symptoms, keeps individuals more comfortable, and reduces the chance of developing Barrett’s esophagus. Barrett’s esophagus can be responsible for an increased risk of developing esophageal cancer.

• One who receives a laparoscopic approach of Nissen fundoplication gets benefits like less pain, shorter hospital stays, and faster recovery.

Other effective treatment options for GERD include lifestyle modifications, exercise, stress management, and NF.

What Are the Complications and Risks Associated With Nissen Fundoplication?

• The primary and most significant complication of Nissen fundoplication is that symptoms may recur.

• In most cases, the individual requires another surgery within 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, you 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 any of these signs are noticed.

• Also, lung infections, like pneumonia and dumping syndrome, are potential complications of the surgery.

Conclusion

Individuals who suffer from GERD symptoms may need an NF surgical procedure. This type of surgery helps to strengthen or restore the lower esophageal sphincter (LES). LES is the main valve responsible for acid reflux, which is present between the stomach and the esophagus. Among the two types of NF, the laparoscopic method has the least risks and complications.

Research is being conducted to improve procedures for alleviating GERD symptoms, such as the use of magnetic devices around the sphincter, and minimally invasive procedures performed through the mouth without skin incisions. Complete and partial wraps are still in use and are the most commonly used procedures. The newer therapies have shown promising short-term results, but further research is still needed. For more information, you can consult a gastro health specialist online.

Key Takeaways

• When GERD cannot be treated with only medicines, surgery can be used to relieve its symptoms.

• NF is the most commonly used surgical procedure to treat GERD.

• NF can give lasting results for GERD.