Laparoscopic Nissen Fundoplication

What is Laparoscopic Nissen Fundoplication

  • Laparoscopic Nissen fundoplication is a surgery to relieve heartburn and other problems caused by gastric fluids flowing up into your esophagus.
  • The esophagus is the part of the body that moves food from your mouth to your stomach.
  • Normally, the muscle that sits between your stomach and your esophagus (lower esophageal sphincter, LES) keeps stomach fluids in your stomach.
  • In some people, the LES does not work properly, and stomach fluids flow up into the esophagus.
  • This can happen when part of the stomach bulges through the LES (hiatal hernia).
  • The backward flow of stomach fluids can cause a type of severe and long-lasting heartburn that is called gastroesophageal reflux disease (GERD).
  • You may need this surgery if other treatments for GERD have not helped.

What are the important technical steps of a Nissen fundoplication? 

  • Laparoscopic Nissen fundoplication is now the procedure of choice for most patients requiring an antireflux operation.
  • Five trocars are inserted in the upper abdomen to provide access for the laparoscope and instruments. Both the right and the left vagus nerves are identified and preserved.
  • The short gastric vessels are divided in the proximal part of the stomach, thereby mobilizing the fundus so that it can be placed around the distal esophagus without tension (the “shoeshine” maneuver).
  • Dissection is performed to identify the right and left crura of the diaphragm.
  • The distal esophagus is mobilized so that at least 3 cm of the distal esophagus lies without tension in the abdomen.
  • The crura are approximated with nonabsorbable sutures.
  • A bougie (range, 48- to 60-Fr depending on the size of the patient) is placed in the esophagus to prevent an excessively tight fundoplication.
  • Some surgeons anchor the wrap to the crura of the diaphragm and to the esophagus to help prevent it from herniating into the chest.
  • If there is a large hiatal hernia or if closure of the crura appears under tension, reinforcing the crural sutures with absorbable mesh reduces the rates of herniation.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Damage to other structures or organs. This can include damage to the lung, causing a collapsed lung.
  • Trouble swallowing (dysphagia).
  • Blood clots.

What happens before the procedure?

Medicines

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
    • Taking over-the-counter medicines, vitamins, herbs, and supplements.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

General instructions

  • Plan to have someone take you home from the hospital or clinic.
  • Ask your health care provider what steps will be taken to help prevent infection. These may include:
    • Removing hair at the surgery site.
    • Washing skin with a germ-killing soap.

What happens during the procedure?

  • An IV will be inserted into one of your veins.
  • You will be given a medicine to make you fall asleep (general anesthetic).
  • The surgeon will make a small incision in your abdomen and insert a tube through the incision.
  • Your abdomen will be filled with a gas. This helps the surgeon see your organs better, and it makes more space to work.
  • The surgeon will insert a thin, lighted tube (laparoscope) through the small incision. This allows your surgeon to see into your abdomen.
  • The surgeon will make several other small incisions in your abdomen to insert the other instruments that are needed during the procedure.
  • Another instrument (dilator) will be passed through your mouth and down your esophagus into the upper part of your stomach. The dilator will prevent your LES from being closed too tightly during surgery.
  • The upper part of your stomach will be wrapped around the lower part of your esophagus and will be stitched into place. This will strengthen the lower esophageal sphincter and prevent reflux.
  • If you have a hiatal hernia, it will be repaired.
  • The gas will be released from your abdomen.
  • All instruments will be removed, and the incisions will be closed with stitches (sutures).
  • A bandage (dressing) will be placed on your skin over the incisions.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
  • You will be given pain medicine as needed.
  • Your IV will be kept in until you are able to drink fluids.
  • You will be encouraged to get up and walk around as soon as possible.

Summary

  • Laparoscopic Nissen fundoplication is a surgery to relieve heartburn and other problems caused by gastric fluids flowing up into your esophagus.
  • You may need this surgery if other treatments for GERD have not helped.
  • Follow instructions from your health care provider about eating and drinking before the procedure.
  • Your surgeon will use a thin, lighted tube (laparoscope) that is inserted through a small incision, allowing the surgeon to see into your abdomen.

Care After Laparoscopic Nissen Fundoplication

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

  • Trouble swallowing (dysphagia).
  • Discomfort when you swallow.
  • Abdominal soreness.
  • Bloating.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Ask your health care provider or pharmacist if you can crush any pill that you are taking. Take only liquid medicines as directed.
  • Do not drive or use heavy machinery while taking prescription pain medicine.

Incision care

  • Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
  • Check your incision area every day for signs of infection. Check for:
    • Redness, swelling, or pain.
    • Fluid or blood.
    • Warmth.
    • Pus or a bad smell.

Eating and drinking

  • Follow instructions from your health care provider about eating or drinking restrictions. Follow these instructions carefully.
    • You may need to follow a liquid-only diet for 2 weeks, followed by a diet of soft foods for 2 weeks.
    • You should eat slow, take small bites, and chew the food carefully.
    • You should eat or drink in an upright position.
    • You should return to your usual diet gradually.
  • Drink enough fluid to keep your urine pale yellow.

Activity

  • Rest as told by your health care provider.
  • Avoid sitting for a long time without moving. Get up to take short walks every 1–2 hours. This is important to improve blood flow and breathing.
  • Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
  • Avoid activities that take a lot of effort.
  • Ask your health care provider what activities are safe for you. Ask when you can:
    • Return to sexual activity.
    • Drive.
    • Go back to work.
  • Return to your normal activities as told by your health care provider.

Bathing

  • Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.

General instructions

  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay healing after surgery. If you need help quitting, ask your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you have:

  • A fever.
  • Pain that does not go away with medicine.
  • Frequent nausea or vomiting.
  • Painful bloating.
  • Constipation.
  • Trouble swallowing.
  • A cough that does not go away.
  • An incision that opens up.
  • An incision area that feels warm to touch.
  • Redness, swelling, or pain in any incision areas.
  • Fluid, blood, or pus coming from any incision.

Get help right away if:

  • You have severe pain or severe bloating.
  • You are unable to swallow.
  • You have vomiting that does not stop.
  • You have blood in your vomit.
  • You have trouble breathing.

Summary

  • After the procedure, it is common to have trouble swallowing or have discomfort when you swallow.
  • Follow instructions from your health care provider about eating or drinking restrictions. You may need to follow a liquid-only diet for 2 weeks, followed by a diet of soft foods for 2 weeks.
  • Return to your normal activities as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.
15585

Sign up to receive the trending updates and tons of Health Tips

Join SeekhealthZ and never miss the latest health information

15856