Laparoscopic Anti Reflux Surgery / Nissen Fundoplication

What Is Nissen Fundoplication?


Nissen Fundoplication, Laparoscopic Anti-Reflux Surgery, GERD Surgery, Acid Reflux


Nissen Fundoplication is a procedure targeted at treating heartburn due to Gastroesophageal Reflux Disorder, more commonly referred to as GERD. 


Gastroesophageal Reflux Disease (GERD) is a digestive disorder that occurs when stomach juices or food and fluids frequently flow back up from the stomach into the oesophagus. This phenomenon is also known as acid regurgitation, acid reflux, or gastroesophageal reflux. 


The frequent occurrence of gastroesophageal reflux can also cause the weakening of the muscles along the lower oesophageal sphincter (LES), which controls the opening between the oesophagus and the stomach. Nissen Fundoplication helps strengthen this opening to prevent food and acid from going back up.


This procedure is also one of the most common surgeries used to treat GERD and has a high success rate in helping patients recover and prevent recurrence in the long run.


What Is Nissen Fundoplication Used to Treat?


Nissen Fundoplication is primarily used to treat patients with GERD, or in other cases, patients diagnosed with a hiatal hernia, where the stomach pushes against the diaphragm.


This procedure is usually recommended for patients who experience prolonged periods of severe heartburn. This means that there is daily burning pain behind the chest bone for a few months. Surgery is especially indicated if the pain persists despite medication and lifestyle changes. 


A patient will usually be advised to start with mild treatment or lifestyle changes before being recommended for surgery. These recommendations can include:


  • Weight management, for patients who are overweight or obese
  • Switching one’s diet to include non-acidic or refluxing-causing food 
  • Avoiding alcohol and smoking as they can trigger acid reflux
  • Taking over-the-counter medications such as antacids, H2 receptor blockers, or proton pump inhibitors (PPIs)


Nissen Fundoplication serves to tighten and reinforce the lower oesophageal sphincter (LES). In the procedure, the upper part of the stomach is wrapped around the lower oesophagus’s exterior to strengthen the sphincter.


This procedure is also observed to be highly successful and help improve the patient’s lifestyle in the long run.


How Does Nissen Fundoplication Work?


Nissen Fundoplication can be performed as an open surgery or laparoscopically. In open surgery, the surgeon makes a long incision in your stomach to access the oesophagus. 


On the other hand, most Nissen Fundoplication procedures are performed laparoscopically (also known as keyhole surgery.)


“Laparoscopic” means that the surgeon operates through several small keyhole incisions instead of a single large incision. This procedure is minimally invasive and offers better visualisation than open surgery. 


As compared with traditional fundoplication, laparoscopic fundoplication has a faster recovery time, significantly less pain, and minimal scarring. In both procedures, a Nissen Fundoplication involves wrapping the entire upper part of the stomach around the oesophagus. 


The surgeon takes the top part of the stomach and wraps it around the lower oesophagus. It allows the repair of the muscle around the lower oesophagus. This makes it less likely that acid will flow back up the oesophagus.


What Are the Side Effects of Nissen Fundoplication? 


A Nissen Fundoplication is a relatively safe procedure when performed laparoscopically. This allows smaller incisions to be made and aids in faster recovery. However, as with most surgeries, some patients may experience rare cases of complications. 


The complications may include:


  • Damage to the linings of the stomach, oesophagus or tissues around the lungs during the procedure
  • Infection from the wound
  • Pneumonia
  • Difficulty in swallowing
  • Nausea or the urge to vomit
  • Excessive gas in the stomach
  • Dumping Syndrome (a condition associated with patients who have done gastric or oesophageal surgery where food moves rapidly through the stomach to the small intestines, resulting in abdominal pain and other symptoms.)


In extremely rare cases, a Nissen Fundoplication may fail and result in the recurrence of the reflux symptoms. In such cases, the wrap around the oesophagus could have been too tight or incorrectly placed, resulting in the need to repeat the surgery to fix the failure.


Are There Any Dietary Restrictions After a Nissen Fundoplication? 


A patient who has undergone a fundoplication would be advised to make dietary changes to avoid complications after the procedure. A dietary change can also aid in preventing any long term effects of discomfort following the surgery.


Following the surgery, you will be expected to make the changes to your diet according to the different phases. This is what may be recommended:


  • Recovery Phase (2 weeks after surgery): Liquid or soft diet. You are recommended to consume only liquid for the recovery phase and avoid carbonated beverages. Food such as soup and yoghurt are recommended. 
  • Acclimatisation Phase (3-4 weeks after surgery): Soft to light solid food diet. You can start introducing solid foods that are easily digestible into your diet. These can include bread, mashed potato. Your food should also not be overly spicy or oily to prevent causing discomfort.
  • Maintenance Phase (1 Month after surgery and long term): Solid food diet. You can return to your usual diet. However, you are advised to avoid eating foods that are rough and may become stuck in the oesophagus, such as chicken, steak or nuts.  


How Long Does It Take to Recover From a Nissen Fundoplication? 


A patient who undergoes a fundoplication procedure can be discharged within two days after the surgery. Patients who opt for open surgery may be required to stay longer as the operation involves a bigger incision, requiring more extended periods to recover.


Following the surgery, you will likely require tube feeding in the initial two weeks. After that, patients will resume consumption of a liquid diet for another two weeks before progressing to soft foods and finally returning to eating normally after 1 to 3 months.


Depending on whether you opt for open surgery or laparoscopic surgery for your fundoplication, the recovery of your wound would also differ. 


Similarly, the recovery of the wound will differ between individuals. Most patients should recover within two weeks from the surgery if there are no serious complications or infections observed. 


For a more accurate assessment of your recovery period, you may seek advice from your doctor to get a clearer picture.


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