Laparoscopic Nissen Fundiplication
A Laparoscopic Nissen Fundiplication, or lap Nissen, is a surgical procedure for gastroesophageal reflux disease (GERD). The following are situations that may lead a surgeon to recommend a lap Nissen:
- Complications of GERD not responding to medical therapy including:
- Barrett’s metaplasia - a change in the cells of the distal esophagus
- esophageal stricture - narrowing of the esophagus from scar tissue
- severe esophagitis – inflammation in the esophagus
- Persistent symptoms requiring increased medication
- Atypical symptoms with objective evidence of GERD (asthma, recurrent pneumonia or pneumonitis, hoarseness)
- Paraesophageal hernia (movement of the stomach into the chest cavity) with GERD
- Significant patient circumstances (noncompliance with medication, financial burden, lifestyle choice, age younger than 50)
A lap Nissen is performed through five small incisions. The top part of the stomach is mobilized and then a “wrap” is created with the mobilized part of the stomach to help prevent the gastric contents from refluxing back into the esophagus.
Pre-operatively, four tests are sometimes ordered to determine if the patient is a candidate for a lap Nissen:
- upper endoscopy – an endoscope is used by the surgeon or gastroenterologist to evaluate the esophagus and stomach
- 24 hour pH probe monitoring – a device is placed in the esophagus in the endoscopy suite by an endoscopy nurse to evaluate the amount of reflux
- barium swallow study – x-rays are taken while a patient drinks oral contrast
- esophageal manometry – evaluates how well a patient’s esophagus propels food to the stomach
One or more of these tests may be omitted, depending on a patient’s symptoms.
The day of surgery, the patient will report to the Same Day Surgery Department at Peninsula Regional Medical Center. Their anesthesiologist and surgeon will be available for any final questions. The procedure is performed under general anesthesia in the operating room, and usually lasts one to two hours.
Post-operatively, the patient will be taken to their room where they will stay for one night. The morning after surgery another barium swallow is usually ordered, and the patient is started on a liquid diet. A soft diet is then recommended for three to six weeks after the surgery while the swelling around the wrap decreases.
The patient will follow up with their surgeon one to two weeks after the surgery. Return to regular actively will be up to the discretion of the surgeon, but most patients are instructed to avoid heavy lifting for a few weeks.