Nissen Fundoplication

What is a Nissen Fundoplication?

A Nissen Fundoplication is an operation to prevent acid reflux, where acid from your stomach travels up into your oesophagus (gullet). It involves wrapping the top part of your stomach around your oesophagus.

It is normal for a small amount of acid to travel into your oesophagus. If this happens too often it can cause symptoms of a burning sensation in your chest (‘heartburn’) or acid in the back of your mouth. The acid can cause the lining of your oesophagus to become inflamed (oesophagitis) or scarred.

What are the benefits of surgery?

You should get relief from symptoms of acid reflux without needing to take medication.

Figure - A normal valve and a faulty valve

Are there any alternatives to a Nissen Fundoplication?

Medication that lowers the acid content in your stomach is effective at controlling symptoms and healing the inflammation in your oesophagus.

Surgery is recommended only if the symptoms continue while you are taking the medication, or if you feel that you would prefer to have an operation than take medication for the rest of your life.

There are surgical alternatives to a Nissen fundoplication such as a partial wrap and placing magnetic beads around your oesophagus (LINX procedure).

The procedure

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes 1 to 2 hours.

Your surgeon will use laparoscopic (keyhole) surgery as this is associated with less pain, less scarring and a faster return to normal activities.

They will make several small cuts on your abdomen so they can insert tubes (ports) into your abdomen. Your surgeon will insert surgical instruments through the ports along with a telescope so they can see inside your abdomen and perform the operation.

They will stitch your diaphragm to reduce the size of the hole your oesophagus passes through.

Your surgeon will wrap and stitch the top part of your stomach around your lower oesophagus, to produce a valve effect.

What complications can happen?

Some of these can be serious and can even cause death.

General complications of any operation

Pain
Bleeding
Unsightly scarring of your skin
Developing a hernia in the scar
Infection of the surgical site (wound)
Blood clot in your leg
Blood clot in your lung

Specific complications of this operation

Keyhole surgery complications

Damage to structures such as your bowel, bladder or blood vessels
Developing a hernia near one of the cuts
Surgical emphysema (crackling sensation in your skin caused by trapped carbon dioxide gas)

Nissen Fundoplication complications

Pneumothorax, where air escapes into the space around your lung
Making a hole in your oesophagus or stomach
Tear of the stitches used for the wrap
Damage to your liver
Damage to your spleen
Difficulty swallowing for a few months

Long-term problems

Continued difficulty swallowing where you cannot swallow most foods normally
Incomplete control of reflux symptoms
Weight loss
Abdominal discomfort
Diarrhoea
Tissues can join together in an abnormal way

Following surgery

How soon will I recover?

You should be able to go home the next day.

You should be able to return to work after 3 to 4 weeks, depending on how much surgery you need and your type of work.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

You should make a full recovery, with the symptoms of acid reflux gone or much improved.

Summary

Acid reflux can cause heartburn or acid in your mouth. The acid can cause the lining of your oesophagus to become inflamed or scarred. Surgery may be recommended if your symptoms continue while you are taking medication.

Acknowledgements

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