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Bachelor of Medicine and Surgery MBChB (UCT).
Fellow of South African College of Surgeons
Diploma in Obstetrics & Gynaecology
Laparoscopic Nissen Funduplication
What is a Laparoscopic Nissen Fundoplication?
A Laparoscopic Nissen Fundoplication is a minimally invasive surgical procedure used to treat severe gastroesophageal reflux disease (GERD). It is designed to reinforce the "valve" between your oesophagus (food pipe) and your stomach, preventing stomach acid from flowing back up into the oesophagus.
The procedure is performed using a laparoscope, a thin instrument with a small camera on the end, which allows the surgeon to view the inside of your abdomen on a video monitor. The surgery is done through several small incisions (cuts), rather than one large one, leading to less pain and a quicker recovery for most patients.
Indications: When is this procedure recommended?
A Laparoscopic Nissen Fundoplication is typically recommended for patients who have been diagnosed with GERD and meet one or more of the following criteria:
Symptoms that are not well-controlled by medication: Despite taking proton pump inhibitors (PPIs) or other anti-reflux medications, you continue to experience significant symptoms such as heartburn, regurgitation, chest pain, or difficulty swallowing.- Complications of GERD: You have developed complications from long-term GERD, such as oesophagitis (inflammation of the oesophagus), oesophageal strictures (narrowing of the oesophagus), or Barrett's oesophagus (a precancerous condition).
- Desire to stop taking long-term medication: You are tired of taking daily anti-reflux medications and are seeking a more permanent solution.
- Presence of a hiatal hernia: A hiatal hernia, where part of the stomach pushes up through an opening in the diaphragm, is often corrected during the Nissen fundoplication.
Your doctor will perform a thorough evaluation, including tests like an upper endoscopy, oesophageal manometry, and pH studies, to determine if you are a good candidate for this surgery.
The Procedure: What to expect
- Preparation: Before the surgery, you will be given specific instructions regarding diet and medication. You will need to fast (not eat or drink) for a certain number of hours before the procedure.
- Anaesthesia: The surgery is performed under general anaesthesia, meaning you will be asleep and will not feel any pain.
- Laparoscopy: The surgeon will make several small incisions (usually 3 to 5) in your abdomen. Through these incisions, they will insert the laparoscope and other specialized surgical instruments. The abdomen is inflated with carbon dioxide gas to create space for the surgeon to work.
- Repairing the Hiatal Hernia (if present): If you have a hiatal hernia, the surgeon will first pull the stomach back down into the abdomen and repair the opening in the diaphragm.
- Creating the "Fundoplication": The surgeon will then wrap the upper part of your stomach (called the fundus) around the lower part of your oesophagus. This creates a new, strong valve that reinforces the natural sphincter and prevents stomach acid from flowing back up. The wrap is secured with a few sutures.
- Closure: The instruments are removed, the gas is released, and the small incisions are closed with sutures or surgical glue.
Recovery
After the procedure, you will be taken to a recovery room for monitoring. Most patients are able to go home within one to two days.
- Pain Management: You will likely experience some discomfort at the incision sites, which can be managed with pain medication.
- Diet: You will be given a specific dietary progression plan, starting with liquids, then moving to soft foods, and eventually returning to a normal diet. It is important to follow these instructions carefully.
- Activity: You should avoid heavy lifting and strenuous activity for several weeks to allow the surgical sites to heal. Your doctor will advise you on when you can safely return to your normal activities.
Risks and Complications
Like any surgical procedure, a Laparoscopic Nissen Fundoplication has potential risks. While serious complications are rare, they can include infection, bleeding, injury to the oesophagus or other organs, and difficulty swallowing (dysphagia) or gas-bloat syndrome (a feeling of being bloated or unable to burp) in the short term. Your surgeon will discuss all the potential risks and benefits with you in detail.
Please note: The information provided above and on this website is for education and interest purposes only. It is not intended to replace a personal one-on-one consultation, nor is it meant to substitute professional medical advice, diagnose or treat any condition. A consultation with a specialist and qualified health care provider such as Dr. Mitchell or Dr. Munda is essential for correct diagnosis and management, as well as to answer any queries that you may have. Never disregard or delay in seeking professional medical advice due to something you have read on this website. Dr. Mitchell and Dr. Munda take no responsibility for any errors or omissions present on this website and they are not liable for any consequences that may occur from misinterpretation of the information on this website. In the event of uncertainty or an emergency, please visit your nearest casualty.