Nissen Fundoplication

What is a Nissen fundoplication?

Nissen fundoplication is a surgery to treat gastroesophageal reflux disease (GERD). If you have GERD, the acid in your stomach flows back up to your esophagus. This can happen if your lower esophageal sphincter doesn’t work as it should.

Normally, your sphincter relaxes to let food move from your esophagus to your stomach. It then tightens to keep stomach acid out. A Nissen procedure wraps the top of your stomach (fundus) around the bottom of your esophagus. The wrap reinforces your lower esophageal sphincter so stomach acid stays where it belongs.

You or your child may have this surgery when other treatments don’t ease GERD symptoms.

Other types of fundoplication

The types of fundoplication vary depending on how much of your fundus wraps around the bottom of your esophagus. Your surgeon will explain the different procedures and recommend the one that’s best for your situation. The procedure types are:

• Nissen 360-degree wrap: Your surgeon wraps all your fundus around the bottom of your esophagus.
• Toupet 270-degree wrap: Your surgeon wraps your fundus around a section of the back part of your esophagus.
• Dor anterior 180-degree wrap: Your surgeon reconstructs the section of your esophagus that’s next to your diaphragm. They wrap your fundus halfway around the lower section of your esophagus and attach it to your diaphragm.

How should I prepare for a fundoplication?

Your surgeon may do tests to check for narrowing in your esophagus. They also check for hiatal hernias. A hiatal hernia is a bulge in your stomach at the top of your esophagus. It can worsen your GERD symptoms. Your surgeon will repair the hernia if you have one. Tests include:

• Esophageal manometry test
• Gastrointestinal (GI) X-rays
• pH monitoring test to look for acid in your esophagus
• Upper endoscopy

Your surgeon will explain what you should do before your surgery. They may tell you that you or your child shouldn’t eat or drink anything after midnight on the day of your surgery.

What happens during a Nissen fundoplication?

You may have an open or laparoscopic surgery. You receive general anesthesia so you’re asleep during surgery. The details below describe a total Nissen fundoplication.

Open surgery

During open surgery, your surgeon:

1. Makes one large incision in your abdomen.
2. Wraps the upper part of your stomach (fundus) around the lower part of your esophagus.
3. Closes the incision with staples.

Laparoscopic surgery

During laparoscopic surgery, your surgeon:

1. Makes four to six small incisions in your abdomen.
2. Inserts a laparoscope (a small tube with a camera) into your abdomen.
3. Uses the camera images as guides. They use tiny surgical tools to wrap your upper stomach around your lower esophagus.
4. Closes the incision with stitches.

A procedure typically takes one to three hours to complete.

What are the potential benefits and complications of a Nissen fundoplication?

The procedure eases your acid reflux symptoms when other treatments aren’t successful. Having a Nissen fundoplication also reduces your risk of developing Barrett’s esophagus. This condition can lead to esophageal cancer.

Like all surgeries, there’s a risk of infection. But the most significant risk of a Nissen fundoplication is that your symptoms may come back. You may need to have another procedure.

What are the long-term side effects of Nissen fundoplication?

Common long-term side effects include:

• Bloated belly
• Difficulty vomiting
• Dysphagia

The same procedure that keeps stomach acid out of your esophagus can keep you from throwing up. Your stomach dumps whatever’s upsetting it into your intestines. Eventually, the stuff leaves your body as poop.

What’s the success rate for a fundoplication procedure?

Success rates vary depending on the type of procedure that you have. One study shows that 10% of people who had this surgery needed a second one.

What happens after a Nissen fundoplication?

You or your child may spend one or more days in the hospital after surgery. You or your child may:

• Have a temporary nasogastric tube in your nose if you had an open Nissen fundoplication. The tube clears digestive juice from your stomach while you heal.
• Receive IV fluids so you don’t become dehydrated.
• Receive nutrition through an IV line until you pass gas or poop. Passing gas and pooping are signs that your body is recovering from surgery.

What is the recovery time?

Plan on taking it easy the first few days after surgery. Usually, you can get back to your daily routine after that. But talk to your surgeon if you have a strenuous exercise routine. They may recommend you do light exercise for a few weeks.

Kids who have a Nissen fundoplication may go back to school within a few days. They should avoid strenuous activities for at least three weeks. Ask your child’s surgeon if there are specific activities your child should avoid.

You or your child may have a sore throat after surgery. Your surgeon may recommend that you eat soft foods for the first seven to 10 days after surgery. Start with protein shakes and smoothies and work your way to yogurt, scrambled eggs and pasta.

When should I call my healthcare provider?

Contact your provider if your incision bleeds more than you expect or if you have infection symptoms like:

• Excessive swelling
• Fever
• Redness around your incision
• Skin around your incision that feels warm to the touch

You should also let them know if your symptoms come back after surgery.