What is Nissen Fundoplication?
The nissen fundoplication (fundo) is a surgical technique that strengthens the sphincter (LES). Where the LES is not working correctly then it can cause gastroesophageal reflux disease.
How is laparoscopic Nissen fundoplication performed?
Nissen fundoplication involves constructing a new “valve” between the oesophagus and the stomach by wrapping the upper portion of the stomach around the lowest point of the oesophagus — much the way a bun fits around a hot dog.
In the laparoscopic procedure, surgeons use a trocar (a narrow tube-like instrument) to gain access to the abdomen. A laparoscope (a tiny telescope connected to a video camera) is inserted through the trocar, giving the surgeon a magnified view of the patient’s internal organs on a television monitor.
Here is a video on how this surgery is done:
Studies have shown that more than 90% of patients who undergo the Nissen Fundoplication procedure say their symptoms are cured or improved after 10 years. Many surgeons familiar with both approaches believe that the long-term results will be just as good with the laparoscopic approach because the actual fundoplication is performed in exactly the same manner.
In most cases, patients leave the hospital 2 or 3 days after laparoscopic Nissen fundoplication. This compares with a 6 to 10 day stay following the traditional procedure.
Most laparoscopic patients experience less pain, less scarring, a shorter hospital stay and a quicker recovery than those patients undergoing the open procedure.
The procedure is generally safe and there has been a low or zero mortality is most experienced surgeons hands.
There are some side effects which include:
- Short term difficulty swallowing especially dry or lumpy foods. This is due to bruising of the low oesophagus and can last 3 months.
- Bloating and increased flatulence. This is due to the inability to burp up swallowed air and slowly improves with time.
- Diarrhoea can occur in patients with large hernias caught in the chest as damage to the vagus nerves can occur in reducing the hernia out of the hiatus.
Possible complications include:
- General anaesthetic complications such as heart irregularities, infections etc.
- Bleeding from the spleen or gastric vessels.
- Tearing of the oesophagus resulting in leakage.
- Slippage of the wrap or breakdown of the hiatus resulting in pain or difficulty swallowing.
- Recurrence of the reflux or the associated hiatus hernia.
The incidence of serious problems is very small and patients in the vast majority of cases very happy with the outcome of their surgery. If anything goes wrong at surgery the patient may require an open procedure, laparotomy, to repair the damage.
However, it is important to remember to ask your surgeon before undergoing any type of surgery — whether laparoscopic or traditional — about his or her training and experience.
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Comments
Having recently undergone the full nissen fundopilcation operation recently, I found watching this video extremely helpful. Although I was under great surgical team and had things properly explained to me, it was still good to see the “action”. Thank you for making it available to the public.
I’m not fully recovered yet but very hopefully that I shall be in the future.
Many thanks again.
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[...] that reduce the secretion of this acidic fluid, GERD may be treated with a type of surgery called fundoplication that tightens the junction between the esophagus and [...]