The nissens fundoplication (fundo) is a surgical technique that strenghens the sphincter (LES). Where the LES is not working correctly then it can cause gastro-oesophageal reflux disease.
What happens during fundoplication?
When performing a fundoplication, the part of the stomach that is closest to the entry of the esophagus (the fundus of the stomach) is gathered, and wrapped around the lower end of the esophagus and esophageal sphincter, where it is then sutured (sewn) into place.
This is depicted in the diagram below
During a fundoplication other surgical steps may also be neccessary. In some cases patients may also suffer from a hiatal hernia, in which case they may at the same time pull down the hernial sac from the chest and suture so that it stays with in the abdomen.
Occasionally the opening in the diaphragm through which the esophagus passes from the chest into the abdomen may also be tightened.
In cases where the infant/child has feeding problems a feeding/peg tube may be inserted directly from the stomach.
The Fundoplication procedure can vary depending on the patient and surgeon.
Open nissens fundoplication:
This is open surgery where a large incision in the stomach is made under general anesthetic. Hospitalisation is likely for up to 1-2 weeks. Surgeons sometimes prefer this procedure as they can feel how tight or lose the wrap around the sphincter is during the surgical procedure.
The Laparoscopic technique only requires 5 small holes in the abdomen under general anesthetic. The advantage is a speedier recovery and less post-operative pain. Hospitalisation period of 5 days following the operation can be expected. The procedure can take longer than the open method to perform, and it is harder for the surgeon to judge how tight the wrap around the esophagus is. T
Following a fundoplication procedure a diet plan will be given to you and you should follow it carefully until you have made a full recovery. This is a link to an example of a diet sheet from one of our adult members, given to him post surgery. This diet sheet is for adults only.
Things to consider with the fundoplication: (laprascopic and open)
There are a few points to bear in mind when considering a fundoplication.
- Once the operation is performed bringing up wind (belching) may be difficult. Drinks that have gas, like lemonade or cola etc. may need to be avoided. The same with some foods. Your surgeon should advise you.
- Vommiting may be difficult folllowing a fundoplication.
- Dried foods may be difficult to eat, as without a sauce they may not pass through the wrap so easily.
- Fundoplications can come undone, especially in young children as they grow.
- Not everyone will be medication free afterwards. Some patients still require medication to control symptoms of reflux.
- Some adults and children with severe long term complications may require a feeding/peg tube inserted at the same time.
- On the positive side, in many cases a succesful fundoplication can offer a reflux free life. Where failure to thrive is an issue, often following this procedure, the patient can return to a normal growth and health pattern.
Possible complications and risks
- The wrap comes undone or loosens over time.
- There is a chance in small infants that the nissens fundoplication will open as the child grows.
- the wrap may be sutured to tight and may require dilation.
- Gas bloat syndrome
- Dysphagia (difficulty swallowing)
- Dumping syndrome can be caused by stomach surgery.
Other surgical options:
Partial posterior wrap (toupet)
The nissen fundoplication is the standard surgery for gastroesophaeal reflux disease. There is also the possibility to have a partial wrap performed. The nissens fundoplication is a 360 ° wrap ,were as the toupet is 180° wrap. This procedure is believed to have less complications after the surgery.
Other partial wraps such as 280° may be considered.
This surgery involves the use of an endoscope with in effect a small sewing machine attached to the end, known as a EndoCinch device. The procedure stitches a pleat or plication just below the lower esophageal sphincter muscle. The process is repeated for the necessary amount of pilications.
The surgery can be performed on an outpatient basis under sedation.
Please read some of our members personal stories who have been though both the laparoscopic and open fundoplication.
Written by Tracey (LWR Chairman)