Nissen Fundoplication

Nissen Fundoplication is a surgery in which a sphincter is created at the bottom of the esophagus to prevent acid reflux and treat gastroesophageal reflux disease (GERD).

Some facts about Nissen Fundoplication:

• A significant decrease in acid reflux symptoms can be noticed after Nissen Fundoplication.
• The gastroesophageal reflux disease (GERD) can be treated by tightening the junction between the esophagus and the stomach to prevent acid reflux.
• Oesophagus is a part of your gastrointestinal (GI) system and is the tube between your mouth and stomach.
• GERD or chronic acid reflux is a digestive system disorder in which the oesophagus gets affected. Your stomach acid and contents persistently flow back up through your oesophagus if you have GERD.
• Heartburn is the  most common symptom of GERD which is an uncomfortable burning sensation felt in the middle of the upper abdomen and/or lower chest. Difficulty swallowing and regurgitation of fluid into the esophagus are other typical symptoms.
• People with GERD also may develop some extraesophageal symptoms such as hoarseness, throat-clearing, sore throat, wheezing, chronic cough, and even asthma.
• Nissen Fundoplication can help avoid long term medications and also help prevent complications such as inflammation of the esophagus.

Necessacity of Nissen Fundoplication:

• Mild or moderate symptoms of acid reflux can often be relieved with diet and lifestyle changes. Over the counter and prescription medications such as antacids, H2 blockers and proton pump inhibitors (PPIs) can also help with symptom relief.
• However, surgery may be an option for people who aren't helped by lifestyle changes or medications.
• Repairing or replacing the valve at the bottom of the esophagus, known as the lower esophageal sphincter (LES) can help reduce the symptoms of GERD. The valve normally keeps acid from moving backward from the stomach. The main cause of GERD is weak or damaged LES.
• Untreated GERD can develop into Barrett's esophagus which increases the risk of esophageal cancer.
• Nissen Fundoplication is required if the heartburn that doesn't go away with medications and lifestyle changes.
• Surgery may also be required when you have severe inflammation of your esophagus, narrowing of your esophagus that is not caused by cancer or Barrett's esophagus.
• Inflammation of the esophagus caused by acid reflux can lead to bleeding or ulcers.
• Swallowing becomes difficult as the scars from tissue damage can constrict the esophagus.

Preparation for Nissen Fundoplication:

• Several tests are conducted to determine if a person is a good candidate for Nissen Fundoplication.
• Oobjective evidence of reflux is identified, reflux is correlated with symptoms and other coexisting diseases that may be contributing to symptoms are evaluated before the surgery.
• An upper endoscopy is a must for all patient. In addition a 24-hour pH test with impedance, and an esophageal manometry study is often done. A contrast oesophagram in the early stages of their evaluation will also be done.
• The preparation for surgical procedure may include taking a clear liquid diet one or two days before surgery, not eating on the day of surgery and taking a medication to cleanse your bowels the day before surgery.

Procedure for Nissen Fundoplication:

• The LES is reinforced to recreate the barrier that stops reflux from occurring by wrapping a portion of the stomach around the bottom of the esophagus. This help to strengthen, augment, or recreate the LES valve.
• Nissen fundoplication is the most common type of fundoplication in which the stomach is wrapped 360 degrees around the lower esophagus.
• undoplication can be performed either as an open surgery or undoplication can be performed as an open surgery.
• The surgeon makes a long incision in your stomach to access the esophagus during an open surgery.
• Several smaller incisions are involved in a laparoscopic surgery. Some instruments are used to make the process less invasive.
• A narrow tube like camera and several long, thin operating instruments are utilized when a minimally invasive surgical technique called laparoscopy is used.
• The camera and instruments are inserted into the abdomen through several small incisions on the abdominal wall and the operation is then performed within the abdominal cavity using camera magnification.
• Less pain, a shorter hospital stay, a faster return to work, smaller scars, and a lower risk of subsequent wound infections and hernias are some of the benefits of laproscopic surgery.
• An open surgery is required if the surgery cannot be safely completed using laparoscopy. This involves an incision in the upper abdomen.
• Transoral Incisionless Fundoplication or TIF is used when open fundoplication is not appropriate. A barrier is created between the stomach and the esophagus using a device called an EsophyX, which prevents reflux of stomach acid.

Recovery from Nissen Fundoplication:

• Recovery from Nissen Fundoplication depends primarily on the type of surgery whether laparoscopic or traditional.
• Laparoscopic surgery has a quicker recovery time and less pain that traditional. However, t may not be appropriate for every person with GERD.
• It requires about a week stay in the hospital and then about six weeks for you to return to work in case of traditional or open surgery.
• Only a few days of stay in the hospital is required in case of laparoscopic fundoplication surgery and the patient will be able to return to work after one week.
• The patient will be on observation during the stay in hospital to ensure that he/she is free of nausea and vomiting, and able to tolerate drinking enough liquids to maintain hydration.
• The dietary restrictions after surgery may differ. Patients are allowed to slowly advance to a solid diet over a 2 to 8 week period of time.
• Crushed or liquid medications are recommended for several weeks after surgery.

Side Effects and Complications of Nissen Fundoplication:

• Although Nissen Fundoplication is considered both safe and effective difficulty, belching or a sensation of abdominal bloating is reported in some patients. Generally it resolves within the first 6 months after surgery.
• An inability to vomit, and increased flatulence and diarrhea is also reported in some patients.
• Long-lasting dysphagia, or difficulty swallowing, is reported in some patients after surgery.
• Dysphagia is common immediately following surgery due to swelling in the area of the operation. Usually this resolves within several weeks after the surgery.
• A liquid or soft diet is recommended to prevent dysphagia after surgery. Patients are also advised to eat slowly, take small bites and chew food well.
• An endoscopic dilation is required to treat persistent or long-standing dysphagia. A revision of the original operation may be required in rare case.
• Complications can arise from general anesthesia, bleeding, infection, and/or injury to nearby organs including the stomach, esophagus, spleen, liver, vagus nerves, aorta, vena cava, diaphragm, lungs, and heart.