Nissen Fundoplication Surgery

Nissen Fundoplication is a surgical procedure commonly employed to treat gastroesophageal reflux disease (GERD) and its associated symptoms. This surgical technique aims to alleviate the discomfort caused by the backflow of stomach acid into the esophagus, which can lead to heartburn, regurgitation, chest pain, and other troublesome symptoms.

What is GERD?

GERD is a chronic condition where the lower esophageal sphincter (LES), a muscular ring that separates the stomach from the esophagus, fails to function properly. This malfunction allows stomach acid to flow back into the esophagus, causing irritation and inflammation. Over time, if left untreated, GERD surgery can lead to complications such as esophageal ulcers, strictures, Barrett’s esophagus, and even an increased risk of esophageal cancer.

Types of Nissen Fundoplication

There are two main types of Nissen fundoplication, a surgical procedure commonly used to treat gastroesophageal reflux disease (GERD):

Complete (360-degree) Nissen Fundoplication: In this procedure, the uppermost part of the stomach (fundus) is wrapped around the oesophagus 360 degrees to stabilize the lower oesophagal sphincter. The tighter valve helps prevent acid reflux.
Partial Fundoplication: A less common variation where the stomach is wrapped around the oesophagus only partially (usually 180 or 270 degrees). This may be done in cases where a complete wrap might cause side effects like difficulty swallowing or gas bloating.

Who will Perform Nissen Fundoplication?

Gastroenterologists and general practitioners often diagnose and manage GERD initially, using medications like proton pump inhibitors (PPIs) or H2 blockers to reduce stomach acid production. If these treatments don’t provide sufficient relief, or if the individual has complications from GERD, they might be referred to a surgeon who specializes in gastrointestinal surgery.

Preparation for Nissen Fundoplication

Nissen Fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD), a condition in which stomach acid flows back into the esophagus, causing heartburn and other symptoms. The surgery involves wrapping the top part of the stomach around the lower esophagus to prevent acid reflux.

If you’re preparing for a Nissen Fundoplication surgery, here are some general steps to follow:

Consultation: Meet with a gastroenterologist or surgeon to assess your condition and determine if Nissen Fundoplication is right for you.
Medical Evaluation: Your doctor may perform tests like endoscopy or pH monitoring to assess GERD severity.
Expectations: Discuss the surgery’s benefits, risks, and recovery process with your doctor.
Pre-Surgery Instructions: Follow fasting, medication, and diet guidelines provided by your doctor before surgery.
Quit Smoking/Alcohol: Stop smoking and alcohol consumption to improve healing and reduce complications.
Arrange Transportation: Make sure someone can drive you home and assist during recovery.
Home Preparation: Prepare your home with necessary supplies, soft foods, and pain relievers for recovery.
Mental Preparation: Practice relaxation techniques to reduce anxiety before surgery.

Procedure of Nissen Fundoplication for GERD Treatment

A Nissen fundoplication is a surgical procedure for treating gastroesophageal reflux disease (GERD) and other related conditions. GERD is when stomach acid and digestive fluids flow back into the esophagus, leading to symptoms like heartburn, regurgitation, and discomfort.

Nissen fundoplication aims to address this issue by reinforcing the lower esophageal sphincter (LES), the valve that separates the esophagus from the stomach. Here’s an overview of what is done during a Nissen fundoplication:

Anesthesia: The patient is given general anaesthesia to ensure they are pain-free.
Incisions: Small incisions are made in the abdomen using laparoscopy.
Exposing LES: The surgeon exposes the lower oesophagal sphincter (LES) and upper stomach.
Stomach Wrapping: The upper stomach (fundus) is wrapped around the LES to prevent acid reflux.
Wrap Types: Full Wrap (360-degree) or Partial Wrap (270-degree) are used to strengthen LES.
Securing the Wrap: The wrap is secured with sutures or staples.
Closing Incisions: The incisions are closed after the procedure.

Full Wrap vs Partial Wrap

Full Wrap (360-degree Nissen fundoplication): This version wraps the fundus around the esophagus in a complete 360-degree circle.
Partial Wrap (270 degrees or Toupet fundoplication): This involves a partial wrap, usually 270 degrees, to achieve the desired anti-reflux effect while potentially reducing the risk of side effects like difficulty swallowing (dysphagia).

Benefits and Considerations

Nissen Fundoplication offers several benefits, including:

Symptom Relief: The procedure effectively reduces or eliminates GERD symptoms, relieving patients from heartburn, regurgitation, and chest pain.
Long-Term Results: Many patients experience long-term improvement in their symptoms and quality of life after undergoing Nissen Fundoplication.
Medication Reduction: Patients often require fewer or no GERD medications after the surgery, potentially saving them from the side effects and costs associated with long-term medication use.

However, it’s essential to consider potential drawbacks as well?

Complications can occur from general anaesthesia, bleeding, infection, and injury to nearby organs.

Gas and Bloating: Some patients may experience increased gas and bloating post-surgery due to changes in the mechanics of the digestive system.
Dysphagia: A small percentage of patients might experience difficulty swallowing, which usually improves over time.
Surgical Risks: As with any surgical procedure, risks are involved, such as infection, bleeding, and adverse reactions to anesthesia.

Recovery After Nissen Fundoplication

After the surgery, the patient is carefully monitored in the recovery area. If laparoscopy was used, the recovery time is often shorter than traditional open surgery. Nissen fundoplication aims to alleviate the symptoms of GERD by reducing the frequency and severity of acid reflux. However, like any surgical procedure, there are potential risks and complications, including difficulty swallowing, gas bloating, surgical site infection, and, rarely, failure of the procedure to provide relief.

Lifestyle changes after Nissen Fundoplication

Nissen Fundoplication is a surgical procedure often used to treat gastroesophageal reflux disease (GERD), where stomach acid flows back into the esophagus, causing heartburn and other symptoms. The surgery involves wrapping the top of the stomach around the lower esophagus to strengthen the lower esophageal sphincter and prevent acid reflux.

After undergoing Nissen Fundoplication surgery, there are several potential lifestyle changes and considerations that individuals might need to make:

Dietary Changes: To prevent reflux, avoid trigger foods like spicy, acidic, and fatty foods. Follow your doctor’s nutritional guidelines.
Eating Habits: Eat smaller meals, chew food well, and avoid overeating to reduce discomfort.
Meal Timing: Avoid eating close to bedtime and elevate your bed to reduce nighttime reflux.
Physical Activity: Light walking aids digestion, but strenuous activity post-surgery should be avoided to protect the surgical site.
Weight Management: Keep weight in check to reduce pressure on the stomach and minimize reflux.
Hydration: Drink water during the day but reduce your intake of large quantities of water during meals to avoid reflux.
Smoking and Alcohol: Quit smoking and keep alcohol low to prevent reflux.
Stress Management: Practice relaxation methods to minimize stress and reduce reflux symptoms.
Follow-up Care: Attend follow-up appointments to track progress and adjust the post-surgery plan.

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