Nissen fundoplication is a surgical procedure usually performed on individuals suffering from gastroesophageal gastric reflux disease (GERD). It is often performed on those whose symptoms respond poorly to GERD medications and lifestyle changes. One of the most common symptoms of GERD is heartburn, where stomach acids go back into the esophagus. This is frequently caused by the inappropriate relaxation of the lower esophageal sphincter (LES), a ring of muscle around the lower portion of the esophagus. The LES generally closes after food enters the stomach, thus preventing stomach contents from going back.
The complications of GERD, when not given appropriate treatment, include bleeding, ulceration, and narrowing of the esophagus. Before a Nissen fundoplication is recommended for treatment, GERD patients are primarily given medications for relief of symptoms as well given advice to change their lifestyle habits. These lifestyle changes include losing weight, and avoiding certain foods like alcohol, spices, chocolates, and coffee. Smoking should also be stopped as it reduces the pressure of the LES. Drinking carbonated beverages and citrus juices may also aggravate GERD symptoms, and thus, should also be avoided.
Patients who fail to improve after three months despite taking medications and observing lifestyle changes may have to undergo Nissen fundoplication. There are some GERD patients who may also opt for Nissen fundoplication in order to avoid taking medications for a long time. Others showing complications of ulceration and narrowing of the esophagus are also frequently advised to get such a surgical procedure.
There are two ways Nissen fundoplication can be done — through open surgery and laparoscopic surgery. With open-surgery Nissen fundoplication, the surgeon usually makes a 6- to 10-inch opening in the middle of the abdomen to visualize the area to be repaired. He then pulls the fundus, the stomach's upper part, and wraps it around the esophagus' lower portion. This is to strengthen the barrier between the stomach and the esophagus, thus preventing the regurgitation of stomach acids into the esophagus.
In laparoscopic Nissen fundoplication, the surgeon usually makes three small openings in the patient's abdomen. Through these small openings, a thin tube with camera and other surgical instruments are inserted. With the aid of the camera to visualize the stomach and esophagus, the surgeon then proceeds to wrap the fundus around the lower part of the esophagus. The laparoscopic method is said to have more advantages than the open-surgery method. These include less tissue damage, shorter hospital stay, faster recovery time, and lower risk for infection.