Nissen fundoplication

Nissen Fundoplication

Diagram of a Nissen fundoplication procedure.

Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. It is named after Dr. Rudolf Nissen, who first performed the procedure in 1955. The operation involves wrapping the fundus of the stomach around the lower end of the esophagus to reinforce the lower esophageal sphincter (LES), thereby preventing acid reflux.

Indications

Nissen fundoplication is primarily indicated for patients with severe GERD that is not responsive to medical therapy. It is also used to treat hiatal hernia, especially when it is associated with reflux symptoms. Other indications include Barrett's esophagus, recurrent esophagitis, and complications such as esophageal stricture.

Procedure

The procedure can be performed using either an open or a laparoscopic approach. The laparoscopic method is more common due to its minimally invasive nature, which results in shorter recovery times and less postoperative pain.

During the surgery, the surgeon mobilizes the fundus of the stomach and wraps it around the lower esophagus. This wrap is then sutured in place to create a new valve mechanism at the gastroesophageal junction. The wrap is typically a 360-degree complete wrap, known as a "Nissen" wrap.

Variations

There are several variations of the fundoplication procedure, including the Toupet fundoplication, which involves a 270-degree partial wrap, and the Dor fundoplication, which is an anterior 180-200 degree wrap. These variations are sometimes used in patients with impaired esophageal motility to reduce the risk of postoperative dysphagia.

Complications

Watercolour illustration of the Nissen method.

Complications of Nissen fundoplication can include dysphagia, gas-bloat syndrome, and the inability to belch or vomit. Dysphagia, or difficulty swallowing, is the most common complication and may require dilation or even revision surgery. Gas-bloat syndrome occurs when patients are unable to expel gas from the stomach, leading to bloating and discomfort.

Postoperative Care

After the surgery, patients are usually advised to follow a liquid or soft diet for several weeks to allow the surgical site to heal. Gradual reintroduction of solid foods is recommended. Patients are also advised to avoid carbonated beverages and large meals to minimize discomfort.

Outcomes

Nissen fundoplication is generally successful in controlling GERD symptoms, with most patients experiencing significant relief from heartburn and regurgitation. Long-term studies have shown that the majority of patients remain symptom-free for many years after the procedure.

Related Pages

• Gastroesophageal reflux disease
• Hiatal hernia
• Laparoscopic surgery
• Esophagus