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Laparoscopic Nissen Fundoplication (Treatment of GERD)

 

 

WHAT IS GERD?

Gastroesophageal reflux disease (GERD) is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus.
Gastroesophageal refers to the stomach and esophagus, and reflux means to flow back or return. Gastroesophageal reflux is the return of acidic stomach juices, or food and fluids, back up into the esophagus. After food passes through the esophagus into the stomach, a muscular valve called the lower esophageal sphincter (LES) closes, preventing the movement of food or acid upward. Gastroesophageal reflux occurs when the LES relaxes inappropriately, allowing acid from the stomach to flow backward into the esophagus.

WHAT ARE THE SYMPTOMS OF GERD?

Heartburn, also called acid indigestion, is the most common symptom of GERD.
If left untreated, gastroesophageal reflux can cause esophageal ulcers, esophageal bleeding, and narrowing of the esophagus (peptic stricture).
A hiatal hernia may be associated with GERD. Severe heartburn may also result from hiatal hernia. A hiatal hernia is caused by an opening in the diaphragm, a flat muscle that separates the chest from the abdomen, allowing a portion of the stomach to protrude into the chest. This condition can then cause the LES to fail. Although most cases of gastroesophageal reflux are caused by a weakened valve, there are other causes that need to be assessed by your doctor.

HOW IS GERD USUALLY TREATED?

Treatment can include lifestyle changes, such as weight reduction, avoiding certain types of food and taking medications to alleviate symptoms. Surgery may be an option when treatment with medications does not completely relieve symptoms. It's also a good option for patients whose symptoms are well controlled but who don't want to take medication, and for patients with complications of reflux disease, such as ulcers, strictures or Barrett's esophagus.
Anti-reflux operations (Nissen fundoplication) may help patients who have persistent symptoms despite medical treatment.

WHAT IS NISSEN FUNDOPLICATION?

During the fundoplication surgery, the surgeon improves the natural barrier between the stomach and the esophagus by wrapping a part of the stomach known as the gastric fundus around the lower esophagus. This prevents the flow of acids from the stomach into the esophagus, and strengthens the valve between the esophagus and stomach, which stops acid from backing up into the esophagus as easily. This procedure is often done using a laparoscopic surgical technique. It can also be done as traditional (open) surgery.

A laparoscopic surgical procedure is an alternative to traditional or what is known as "open" surgery, in which a large incision must be made. Surgeons provide patients with a technologically advanced option. Now, minimally invasive surgery is used to treat GERD. Our surgeons use laparoscopic surgery to make incisions only millimeters in size. Laparoscopic surgery eliminates the need for a long incision. Small incisions are made to accommodate small tubes called "trocars." These create a passageway for special surgical instruments and a laparoscope.
A laparoscope is a fiber-optic instrument that is inserted in the abdominal wall. This device transmits images from within the body to a video monitor, allowing the surgeon to see the operative area on the screen.
During the laparoscopic Nissen fundoplication procedure, surgeons use small surgical tools and a laparoscope to repair the muscle that separates the stomach and esophagus.

Laparoscopic surgery has many advantages over traditional surgery. Less scarring and recovery time are two of the most compelling advantages of this procedure. Hospital stays are reduced and total recovery time is cut in half. The risk of infection is also lower because of the smaller incisions.
Laparoscopic surgery usually requires only a one-day hospital stay instead of four to five days required for traditional surgery. In many cases a patient's total recovery time can be as little as one to two weeks, compared with four to six weeks for traditional surgery.

ARE YOU A CANDIDATE FOR NISSEN FUNDOPLICATION?

Surgical candidates are those whose heartburn is not well controlled with medicine, those who want to fix the problem without having to take medicine long term, and those who are having complications from reflux, including ulcers, strictures, hernias or Barrett's esophagus.

WHAT PREPARATION IS REQUIRED?

Patients are counseled before the operation about lifestyle and dietary adjustments that are needed for about six weeks following surgery. They are advised to eat smaller amounts of food at each meal, to chew their food well, and avoid chewing gum and drinking carbonated beverages, to make sure the surgery will heal properly.

WHAT SHOULD I EXPECT AFTER SURGERY?

The laparoscopic surgery often requires a hospital stay of only 23 hours. You should be able to return to normal activities between one and two weeks, compared with four to six weeks for traditional surgery.

The success rate for the minimally invasive surgery is 90 to 95 percent for patients who have the typical symptoms of GERD, such as heartburn, regurgitation, or belching. For those whose with less typical symptoms, including hoarseness and chronic cough, the surgery is about 70 to 80 percent effective at relieving their symptoms.

WHEN TO CALL YOUR DOCTOR

Be sure to call your physician or surgeon if you develop any of the following:

  • Persistent fever over 101 degrees F (39 C)
  • Bleeding
  • Increasing abdominal swelling
  • Pain that is not relieved by your medications
  • Persistent nausea or vomiting
  • Profuse sweating with chills
  • Persistent cough or shortness of breath
  • Purulent drainage (pus) from any incision
  • Redness surrounding any of your incisions that is worsening or getting bigger
  • You are unable to eat or drink liquids
 
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