Reflux Surgery

Laparoscopic Nissen fundoplication involves mobilizing the upper curve of the stomach (the fundus) so that is can be wrapped around the esophagus and sewn into place so that the lower portion of the esophagus passes through a small tunnel of stomach. This surgery increases the pressure of the valve between the esophagus and stomach (lower esophageal sphincter, or LES), which prevents acid from backing up into the esophagus as easily thereby reducing the symptoms of GERD.

What To Expect After Surgery

The procedure usually takes less then an hour to perform and most patients will spend one night in the hospital and be completely recovered in 1-2 weeks and back to a normal diet within 4 weeks. Most patients can return to work in less then a week. As with any major surgery general anesthesia is used. Operations are performed with a laparsocopic approach (generally 5 small incisions).

Why It Is Done

Fundoplication surgery is most often used to treat GERD symptoms that are likely to be caused in part by a hiatal hernia and that have not been well controlled by medicines. The surgery may also be used for some people who do not have a hiatal hernia. However, surgery also may be an option when:

  • Treatment with medicines does not completely relieve your symptoms, and the remaining symptoms are proved to be caused by reflux of stomach juices.
  • You do not want or, because of side effects, you are unable to take medicines over an extended period of time to control your GERD symptoms, and you are willing to accept the risks of surgery.
  • You have symptoms that do not adequately improve when treated with medicines. Examples of these symptoms are asthma, hoarseness, or cough along with reflux.

How Well It Works

Studies show that laparoscopic fundoplication improves or eliminates GERD symptoms in over 90% of patients and most are completely off medications. A successful surgery does not guarantee that you will never have symptoms again. Some studies show that only about 1 out of 10 people who have fundoplication surgery done by an experienced surgeon have symptoms come back in the 2 years after surgery. But there isn’t much research on how many people have symptoms come back after more than 2 years. But compared to people who do not have surgery, people who do have surgery are less likely to need medicine every day and have less severe symptoms when they stop taking medicine. Also, people who have surgery for GERD seem to be happy with the results, even if their symptoms do come back and they have to take medicine again.

How is the Operation Performed

As the name indicates, the surgery is performed with a laparoscopic approach (TV camera).  This involves making several small incisions on the abdomen and inflating it with CO2 gas to create a a working space in order to accomplish the specific steps of the operation.  See Video Below:

Risks

Potential risks/side effects or complications following fundoplication surgery include:

  • Difficulty swallowing because the stomach is wrapped too high on the esophagus or is wrapped too tightly.
  • The esophagus sliding out of the wrapped portion of the stomach so that the valve (lower esophageal sphincter) is no longer supported (slipped nissen)
  • Heartburn that comes back.
  • Bloating and discomfort from gas buildup because the person is not able to burp as easily (gas bloat).
  • Excess flatus