Nissen fundoplication is a surgical procedure performed to treat hiatal hernias and acid reflux, also known as gastroesophageal reflux disease (GERD). Acid reflux occurs when stomach acid backs up into the esophagus. This can cause complications such as heartburn and can lead to damage to the lining of the esophagus.
When lifestyle changes and over-the-counter medications are not enough to treat these conditions, your doctor may suggest surgery. Nissen fundoplication prevents the flow of acid into the esophagus and strengthens the valve between the esophagus and stomach.
What Happens During Nissen Fundoplication?
Nissen fundoplication can either be performed as a traditional (open) or laparoscopic surgery. Both surgeries use general anesthesia and usually take anywhere from 2 to 4 hours to perform. During an open Nissen fundoplication, the surgeon makes a long incision in your abdomen, which requires a longer recovery time.
During a laparoscopic Nissen fundoplication the surgeon makes three to four small incisions and inserts instruments, including a flexible tube (laparoscope) with a tiny camera through the incisions. Recovery time after laparoscopic surgery is significantly less than open surgery and there is less pain after surgery because there is no large incision to heal. The laparoscopic technique is used more frequently than an open procedure.
In both procedures, the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place so that the lower portion of the esophagus passes through a small tunnel of stomach muscle. This strengthens the valve between the esophagus and stomach, which helps stop acid from backing up into the esophagus.
What Are the Outcomes with Nissen Fundoplication?
More than 90 percent of patients who undergo Nissen fundoplication experience improvement or elimination of their heartburn symptoms, regurgitation and pain when swallowing. Nissen fundoplication heals the damage done to the esophagus by GERD (esophagitis) in about nine out of 10 people.
Seven years after surgery, four out of 10 people who had surgery either had symptoms come back or had esophagitis come back and needed to take more medicine for symptoms or required another operation.
Preparing for Nissen Fundoplication
Your physician will provide you with specific pre-procedure instructions. Prior to Nissen fundoplication, you may be asked to alter the type or dosing of certain medications you are taking. Typically, prior to Nissen fundoplication or any type of surgery, you should not eat or drink anything after midnight the night before the surgery.
What Happens After Nissen Fundoplication?
Laparoscopic Nissen fundoplication may be performed as an outpatient procedure, so you can have your procedure in an ambulatory surgery center, which can provide better accessibility and ease compared to a hospital. Depending on which type of fundoplication you undergo, recovery time will vary. An open Nissen fundoplication will take a longer recovery time because the larger incision needs to heal. With this procedure, patients need to stay in the hospital for several days after surgery. Since the incisions with a laparoscopic Nissen fundoplication are smaller, the recovery time is significantly less. Most people can go back to work or their normal routine in about 2 to 3 weeks after laparoscopic surgery. Patients who undergo open surgery need more time to get back into their routines. This may take 4 to 6 weeks.
After either surgery, you may need to change the way you eat. You may need to eat only soft foods until the surgery heals. You should chew food thoroughly and eat more slowly to give the food time to go down the esophagus.