What is nissen fundoplication?
Nissen fundoplication is a surgical procedure to treat acid reflux (gastroesophageal reflux disease).
Acid reflux is a condition where acid from the stomach travels up into the oesophagus (gullet). This happens if the valve between the stomach and the oesophagus does not work effectively. Acid reflux can cause ‘heartburn’ or acid in the back of the mouth.
What are the benefits of surgery?
Surgery is aimed at curing the symptoms of acid reflux.
Are there any alternatives to surgery?
Drugs that lower the acid content in the stomach are effective at controlling symptoms and healing inflammation.
Surgery is only recommended if the symptoms continue or if you would prefer not to stay on medication.
What does the operation involve?
The operation is performed under a general anaesthetic and usually takes between one and two hours.
The laparoscopic (‘keyhole’) technique is usually used. Your surgeon will make several small cuts on your abdomen. They will place surgical instruments, along with a telescope, inside your abdomen and perform the operation (see figure 1).
Your surgeon will stitch the diaphragm to reduce the size of the hole the oesophagus passes through. They will then wrap and stitch the top part of the stomach around the lower oesophagus, to produce a valve effect.
What complications can happen?
General complications of any operation:
- Unsightly scarring
- Developing a hernia in the scar
- Infection of the surgical site (wound)
- Blood clots
Specific complications of this operation:
a. Laparoscopic complications
- Damage to internal organs
- Developing a hernia near one of the cuts
- Surgical emphysema
b. Nissen fundoplication complications
- Difficulty swallowing for the first few months
- Air in the chest cavity
- Making a hole in the oesophagus or stomach
- Tear of the stitches used for the wrap
- Damage to the liver
- Continued difficulty swallowing
- Incomplete control of reflux symptoms
- Weight loss
- Abdominal discomfort
How soon will I recover?
You should be able to go home the next day.
You should be able to return to work after three to four weeks but this may vary depending on the extent of surgery and your type of work.
Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, you should ask a member of the healthcare team or your GP for advice.
You should make a full recovery, with the symptoms of acid reflux gone or much improved.
Acid reflux can cause heartburn or acid in the mouth. The acid can cause the lining of the oesophagus to become inflamed or scarred. Surgery may be recommended if your symptoms continue while you are on medication.
Paying for your procedure
Nissen fundoplication (laparoscopic) costs are covered by most medical insurance policies, but please check with your insurer first. If you are paying for your own procedure the cost will be explained and confirmed in writing when you book the procedure. Ask the hospital for a quote beforehand, and ensure that this includes the surgeon’s fee, the anaesthetist’s fee and the hospital charge for your procedure.
Author: Mr Simon Parsons DM FRCS (Gen. Surg.)
Illustrations: Hannah Ravenscroft RM
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