Laparoscopic Nissen Fundoplication

Millions of people suffer from Gastroesophageal Reflux Disease (GERD), a chronic condition where stomach acid frequently flows back into the oesophagus, causing heartburn, regurgitation, and discomfort. When lifestyle changes and medications fail to provide lasting relief, Laparoscopic Nissen Fundoplication treatment becomes a viable surgical option.

This minimally invasive procedure strengthens the lower oesophageal sphincter (LES), preventing acid from escaping into the oesophagus. Unlike long-term medication use, this surgery addresses the root cause of reflux, offering long-term relief from GERD symptoms.

This guide provides a detailed breakdown of Laparoscopic Nissen Fundoplication treatment, covering its procedure, benefits, risks, recovery, and alternatives. If you or a loved one struggle with persistent acid reflux, understanding this treatment can help in making an informed decision.

Table of Contents

What is GERD and Its Impact?

Gastroesophageal Reflux Disease (GERD) is a digestive condition where acid from the stomach repeatedly flows back into the oesophagus. The oesophagus is a tube that connects the mouth to the stomach, and when acid frequently enters it, irritation and damage occur.

The lower oesophageal sphincter (LES) normally acts as a barrier, preventing acid from moving upwards. However, when the LES weakens or relaxes abnormally, acid reflux becomes frequent, leading to GERD.

Common Symptoms of GERD

Heartburn: A burning sensation in the chest, usually after eating.
Regurgitation: Acid or food backing up into the throat or mouth.
Difficulty swallowing (Dysphagia): A feeling of food getting stuck.
Chronic cough: Persistent throat irritation.
Hoarseness or sore throat: Acid exposure affecting the vocal cords.
Bad breath: Due to undigested food or acid reaching the mouth.

Long-Term Effects of GERD

If left untreated, GERD can lead to serious complications such as:

Oesophagitis: Inflammation of the oesophagus lining.
Barrett’s Oesophagus: Pre-cancerous changes in the oesophagus.
Oesophageal Strictures: Narrowing of the oesophagus due to scar tissue.
Increased risk of oesophageal cancer.

When GERD symptoms persist despite medication, Laparoscopic Nissen Fundoplication treatment may be necessary to restore proper function to the LES and prevent further complications.

Why is Laparoscopic Nissen Fundoplication Needed?

Not everyone with GERD requires surgery. Many people manage their symptoms with dietary changes, lifestyle modifications, and medications. However, for some patients, these approaches are not effective. Surgery may be necessary when:

Medications fail to control GERD symptoms.
Acid reflux leads to complications such as oesophagitis or Barrett’s oesophagus.
A hiatal hernia contributes to severe reflux symptoms.
Long-term medication use causes unwanted side effects.
Patients seek a permanent solution to GERD rather than relying on medications.

How Does Surgery Help?

Laparoscopic Nissen Fundoplication treatment strengthens the LES by wrapping the upper part of the stomach (fundus) around the lower oesophagus, creating a one-way valve. This prevents acid reflux and restores normal digestion.

Advantages of Surgery Over Medication

Permanent relief: Unlike medication, which only reduces acid production, surgery stops reflux altogether.
Prevention of long-term complications: Reduces the risk of Barrett’s oesophagus and oesophageal cancer.
Fewer side effects: Medications like proton pump inhibitors (PPIs) can lead to nutrient deficiencies and kidney issues over time.
Better quality of life: Patients can eat normally without experiencing severe reflux.

Surgery offers a long-term solution for GERD sufferers who struggle with persistent acid reflux despite medical treatment.

The Laparoscopic Nissen Fundoplication Procedure

Laparoscopic Nissen Fundoplication treatment is a minimally invasive procedure that strengthens the lower oesophageal sphincter (LES) to prevent acid reflux. The surgeon wraps the upper stomach (fundus) around the oesophagus to create a tighter seal.

Step-by-Step Breakdown of the Procedure

Step 1: Anaesthesia Administration

The patient is given general anaesthesia so that they remain asleep and pain-free during the surgery.
An intravenous (IV) line is inserted to provide fluids and medications.

Step 2: Creating Small Incisions

The surgeon makes four to five small incisions in the abdomen.
These incisions act as entry points for the laparoscopic surgical instruments.

Step 3: Inserting the Laparoscope

A laparoscope (a small camera) is inserted through one of the incisions.
The camera sends live images to a monitor, allowing the surgeon to perform precise movements.

Step 4: Performing the Fundoplication

The top portion of the stomach (fundus) is wrapped around the lower oesophagus.
The stomach wrap is stitched into place, reinforcing the weakened LES.
If a hiatal hernia is present, the surgeon repairs it during the same procedure.

Step 5: Closing the Incisions

Once the procedure is completed, the instruments are removed.
The small incisions are closed using sutures or surgical glue.

Time Taken and Hospital Stay

Surgical time: 1 to 2 hours
Hospital stay: Most patients go home within 24 to 48 hours

Preparation Before Surgery

Before undergoing Laparoscopic Nissen Fundoplication treatment, patients must take several steps to ensure a smooth and successful surgery. Proper preparation improves surgical outcomes, reduces the risk of complications, and speeds up recovery.

Medical Evaluations and Tests

Surgeons require several diagnostic tests to assess the severity of Gastroesophageal Reflux Disease (GERD) and determine whether Laparoscopic Nissen Fundoplication treatment is the best option. These tests include:

Barium Swallow X-ray

Patients drink a chalky liquid containing barium.
X-rays capture images of the oesophagus, stomach, and intestines.
This test identifies narrowing, ulcers, and reflux severity.

Oesophageal Manometry

A thin tube is inserted into the nose and down the oesophagus.
It measures muscle contractions in the oesophagus during swallowing.
This test ensures the oesophagus functions properly before surgery.

24-Hour pH Monitoring

A small acid sensor is placed in the oesophagus.
It monitors acid reflux activity over 24 hours.
It confirms whether acid reflux is the main cause of symptoms.

Upper Endoscopy (EGD)

A thin, flexible tube with a camera is inserted through the mouth.
The doctor examines the oesophagus, stomach, and intestines for signs of damage, ulcers, or inflammation.

Dietary and Lifestyle Changes Before Surgery

Patients should follow specific dietary restrictions before surgery to reduce complications and promote healing.

Dietary Recommendations

Two Weeks Before Surgery:

Avoid spicy, fatty, and acidic foods.
Stop alcohol and carbonated beverages.
Drink plenty of water and eat small, frequent meals.

One Week Before Surgery:

Switch to a soft diet (yoghurt, mashed potatoes, soups).
Reduce caffeine intake.

24 Hours Before Surgery:

Consume only clear liquids (broth, water, apple juice).
Do not eat solid foods.

Night Before Surgery:

No food or drink after midnight.

Medication Adjustments

Some medications increase bleeding risk or interfere with anaesthesia. Patients should consult their doctor about stopping or adjusting these medications:

Stop taking blood thinners (Aspirin, Warfarin) at least 1 week before surgery.
Avoid anti-inflammatory drugs (Ibuprofen, Naproxen)
Consult your doctor about stopping heartburn medications.

Recovery After Surgery

Recovery after Laparoscopic Nissen Fundoplication treatment is an essential phase that determines the long-term success of the procedure. While the surgery provides relief from acid reflux and GERD symptoms, the body requires time to adjust to the new structure of the stomach and oesophagus.

Immediate Recovery in the Hospital

After surgery, patients are moved to a recovery room, where medical staff monitor their condition.

✔ Vital signs (heart rate, blood pressure, oxygen levels) are checked regularly.
✔ Pain is managed with IV medications.
✔ Patients are encouraged to take deep breaths to prevent lung complications.

Home Recovery Guidelines

Dietary Progression

Diet changes are essential after surgery to allow the stomach to heal.

Week 1-2: Liquid diet (broths, smoothies, herbal tea).
Week 3-4: Soft foods (mashed potatoes, yoghurt, scrambled eggs).
Week 5-6: Gradual reintroduction of solid foods.

Note: Avoid carbonated drinks, caffeine, spicy foods, and hard-to-digest meats during the first few weeks.

Physical Activity Restrictions

Patients must take precautions to prevent strain on the surgical area.

Short walks daily – Prevents blood clots and improves digestion.
No heavy lifting for at least 6 weeks.
Sleep with the head elevated to prevent reflux.

Common Side Effects and Management

1. Difficulty Swallowing (Dysphagia)

Occurs in 40-50% of patients in the first few weeks.
Improves as the oesophagus adapts.
Solution: Eat slowly, chew food thoroughly, and take small bites.

2. Bloating and Gas Build-up

Caused by changes in the stomach’s ability to release gas.
Solution: Avoid gassy foods, eat smaller meals, and take anti-gas medication if needed.

When to Call a Doctor?

Severe chest pain or difficulty breathing.
High fever or excessive vomiting.
No bowel movement for more than 3 days.

By following the recommended post-surgery care, patients recover smoothly and experience long-term relief from acid reflux.

Potential Risks and Complications

While Laparoscopic Nissen Fundoplication treatment is a safe and effective procedure, like any surgery, it comes with potential risks and complications. The majority of patients recover without major issues, but understanding the possible side effects and risks can help in early detection and proper management.

Common Short-Term Side Effects

Most patients experience mild and temporary side effects as their body adjusts to the changes in the digestive system.

1. Temporary Difficulty Swallowing (Dysphagia)

What happens? After surgery, some patients struggle to swallow food or liquids due to swelling around the lower oesophageal sphincter. This can cause discomfort, especially in the first few weeks after the procedure.
How long does it last? Most patients see improvement within 4 to 6 weeks as the swelling subsides and the oesophagus adapts to the new structure.
How to manage it? Eating soft foods, chewing thoroughly, and taking small sips of water with meals can help. If symptoms persist beyond 8 weeks, doctors may recommend an oesophageal dilation procedure to gently stretch the area.

2. Bloating and Gas Build-up (Gas Bloat Syndrome)

What happens? After surgery, patients may find it difficult to burp, leading to a feeling of fullness, bloating, and excess gas in the stomach. This occurs because the fundoplication wrap alters the way gas escapes from the stomach.
How long does it last? Gas bloat syndrome is usually temporary and improves within a few months, but some patients may experience long-term issues.
How to manage it? Patients should avoid carbonated drinks, eat slowly, avoid drinking through a straw, and limit gas-producing foods like beans, cabbage, and fizzy drinks. Taking over-the-counter anti-gas medications can also help reduce discomfort.

3. Temporary Nausea or Vomiting

What happens? Some patients experience nausea or occasional vomiting after surgery due to anaesthesia effects, changes in digestion, or difficulty adjusting to the new stomach structure.
How long does it last? This typically resolves within the first 2 weeks after surgery.
How to manage it? Patients should eat small, frequent meals, avoid heavy or greasy foods, and take prescribed anti-nausea medications if needed. If vomiting persists, medical attention is required to ensure the surgical wrap has not become too tight.

Long-Term Complications (Rare Cases)

Although most patients recover well, some may experience long-term issues that require additional treatment or lifestyle adjustments.

1. Chronic Dysphagia (Long-Term Swallowing Problems)

What happens? In rare cases, the fundoplication wrap may be too tight, leading to ongoing difficulty swallowing.
How long does it last? If swallowing difficulties persist beyond 3 months, intervention may be needed.
How to manage it? Doctors may perform an endoscopic dilation procedure to loosen the wrap, helping food pass more easily through the oesophagus.

2. Recurrent Acid Reflux (GERD Symptoms Returning)

What happens? Although Laparoscopic Nissen Fundoplication treatment is designed to prevent acid reflux, some patients may develop symptoms again over time. This can occur if the surgical wrap loosens or the patient gains excessive weight.
How long does it last? Reflux recurrence can develop years after surgery, with 5-10% of patients needing revision surgery.
How to manage it? Patients should maintain a healthy weight, avoid overeating, and follow a GERD-friendly diet. If symptoms return, doctors may prescribe acid-reducing medications or recommend a follow-up endoscopy.

Final Thoughts

Laparoscopic Nissen Fundoplication treatment offers a highly effective, long-term solution for Gastroesophageal Reflux Disease (GERD). With proper preparation, surgery, and recovery care, most patients experience a dramatic improvement in their quality of life.

If you suffer from persistent acid reflux and medication isn’t working, speak to a specialist about whether this procedure is right for you. Always consult a healthcare professional before undergoing surgery.