Nissen Fundoplication Procedure for Acid Reflux?

Discussion in 'Fibromyalgia Main Forum' started by Lendy5, Aug 3, 2006.

  1. Lendy5

    Lendy5 New Member

    Hi Everyone,

    Has anyone had this procedure or know of anyone that has?

    I suffer horribly from GERD and my Doctors want me to have this done. They say it will eliminate my acid reflux all together and I will no longer have to take the meds to control this.

    Any information is greatly appreciated

    carolin

  2. Lendy5

    Lendy5 New Member

  3. KerryK

    KerryK Member

    I had it done for my severe reflux condition. It worked. I have not had to take any stomach remedies since, now 8 years. I can also eat anything I want to now. However, because of my tighter belly muscles, they could not do it endoscopically, so it was hellishly painful and the recovery was very long. In the end, it was worth it.

    Good luck!
  4. kjfms

    kjfms Member

    Here is an excerpt of a good article on the procedure and the site.


    http://www.surgeryencyclopedia.com/Fi-La/Gastroesophageal-Reflux-Surgery.html


    Description-Nissen Fundoplication Procedure.


    The most common type of gastroesophageal reflux surgery to correct gastroesophageal reflux disease is Nissen fundoplication. Nissen fundoplication is a specific technique that is used to help prevent the reflux of stomach contents back into the esophagus.

    When Nissen fundoplication is successful, symptoms and further damage to tissue in the esophagus are significantly reduced.

    Prior to Nissen fundoplication, open surgery was required to gain access to the lower esophageal region. This approach required a large external incision in the abdomen of the patient.

    Fundoplication involves wrapping the upper region of the stomach around the lower esophageal sphincter to increase pressure on the lower esophageal sphincter (LES).

    This procedure can be understood by visualizing a bun being wrapped around a hot dog. The wrapped portion is then sewn into place so that the lower part of the esophagus passes through a small hole in the stomach muscle.

    When the surgeon performs the fundoplication wrap, a large rubber dilator is usually placed inside the esophagus to reduce the likelihood of an overly tight wrap.

    The goal of this approach is to strengthen the sphincter; to repair a hiatal hernia, if present; and to prevent or significantly reduce acid reflux.

    Fundoplication was greatly improved with the development of the laparoscope.

    The laparoscope is a long thin flexible instrument with a camera and tiny surgical tools on the end. Laparoscopic fundoplication (sometimes called "telescopic" or "keyhole" surgery) is performed under general anesthesia and usually includes the following steps:

    Several small incisions are created in the abdomen.
    The laparoscope is passed into the abdomen through one of the incisions. The other incisions are used to admit instruments to manipulate structures within the abdomen.
    The abdomen is inflated with carbon dioxide.

    The contents of the abdomen can now be viewed on a video monitor that receives its picture from the laparoscopic camera.
    The stomach is freed from its attachment to the spleen.
    An esophageal dilator is passed through the mouth into the esophagus.

    This dilator keeps the stomach from being wrapped too tightly around the esophagus.


    The portion of the esophagus in the abdomen is freed of its attachments.


    The top portion of the stomach (the fundus) is passed behind the esophagus, wrapped around it 360°, and sutured in place.


    If a hiatal hernia is present, the hiatus (the hole in the diaphragm through which the esophagus passes) is made smaller with one to three sutures so that it fits around the esophagus snugly.

    The sutures keep the fundoplication from protruding into the chest cavity.
    The laparoscope and instruments are removed and the incisions are closed.




    Aftercare

    Patients should be able to participate in light physical activity at home in the days following discharge from the hospital. In the days and weeks following surgery, anti-reflux medication should not be necessary.

    Pain following this surgery is usually mild, but some patients may need pain medication. Some patients are instructed to limit food intake to a liquid diet in the days following surgery.

    Over a period of days, they are advised to gradually add solid foods to their diet. Patients should ask the surgeon about the post-operative diet.

    Such normal activities, as lifting, work, driving, showering, and sexual intercourse can usually be resumed within a short period of time.

    If pain is more than mild and pain medication is not effective, then the surgeon should be consulted in a follow-up appointment.

    The patient should call the doctor if any of the following symptoms develop:

    * drainage from the incision region
    * swallowing difficulties
    * persistent cough
    * shortness of breath
    * chills
    * persistent fever
    * bleeding
    * significant abdominal pain or swelling
    * persistent nausea or vomiting
    * Risks

    Risks or complications that have been associated with fundoplication include:

    * heartburn recurrence

    * swallowing difficulties caused by an overly tight wrap of the stomach on the esophagus

    * failure of the wrap to stay in place so that the LES is no longer supported

    * normal risks associated with major surgical procedures and the use of general anesthesia

    * increased bloating and discomfort due to a decreased ability to expel excess gas

    Complications, though rare, can occur during fundoplication.

    These complications can include injury to such surrounding tissues and organs, as the liver, esophagus, spleen, and stomach.

    One of the major drawbacks to fundoplication surgery, whether it is open or laparoscopic, is that the procedure is not reversible.

    In addition, some of the symptoms associated with complications are not always treatable.

    One study showed that about 10% to 20% of patients who receive fundoplication have a recurrence of gastroesophageal reflux disease symptoms or develop such other problems, as bloating, intestinal gas, vomiting, or swallowing problems following the surgery.

    In addition, some patients may develop altered bowel habits following the surgery.



    Normal results

    One research study found that fundoplication is successful in 50% to 90% of cases. This study found that successful surgery typically relieves the symptoms of gastroesophageal reflux disease and esophagus inflammation (esophagitis).

    The researchers in this study, however, provided no information on the long-term stability of the procedure.

    Fundoplication does not always eliminate the need for medication to control gastroesophageal reflux disease symptoms.

    A different study found that 62% of patients who received fundoplication continued to need medication to control reflux symptoms. However, these patients required less medication than before fundoplication.

    Two studies demonstrated that laparoscopic fundoplication improved reflux symptoms in 76% and 98% of the treated populations, respectively. In an additional study, researchers evaluated 74 patients with reflux disease who received Nissen fundoplication after failure of medical therapy.

    The researchers concluded that 93.8% of the patients had complete resolution of symptoms and did not require anti-reflux medications approximately 14 months after fundoplication.

    Researchers have found that when fundoplication is successful, the resting pressure in the LES increases.

    This increase reflects a return to more normal LES functioning where the LES keeps stomach acid in the stomach through increased pressure.

    Overall, studies have suggested that the vast majority of patients who receive laparoscopic reflux surgery have positive results.

    These patients are either symptom-free or have significant improvements in reflux symptoms.

    The laparoscopic approach has a few advantages over other forms of fundoplication. These advantages include:

    * decreased postoperative pain
    * more rapid return to work
    * decreased hospital stay
    * better cosmetic results
    * Morbidity and mortality rates
    * Mortality is extremely rare during or following fundoplication.

    Complications and side effects are not common following fundoplication, especially using the laparoscopic approach, and are usually mild.

    A review of 621 laparoscopic fundoplication procedures performed in Italy found no cases of mortality and complications in 7.3% of cases.

    The most serious complication was acute dysphagia (difficulty swallowing) that required a re-operation in 10 patients. In general, long-term complications resulting from this procedure are uncommon.





    Questions to ask the surgeon:

    How many times have you performed Nissen or laparoscopic fundoplication?

    Are you a board-certified surgeon?

    What types of outcomes have you had?

    What are the most common side effects or complications?

    What should I do to prepare for surgery?

    What should I expect following the surgery?


    Best of luck to you and I hope this article help a little. Sorry so long.

    Thanks,

    Karen :)