What is a Nissen fundoplication?

A Nissen fundoplication is an operation to prevent acid reflux, where acid from your stomach travels up into your oesophagus (gullet). It involves wrapping the top part of your stomach around your oesophagus. For this reason, the operation is sometimes known as a 'wrap'.

It is normal for a small amount of acid to travel into your oesophagus. If this happens too often it can cause symptoms of a burning sensation in your chest (‘heartburn’) or acid (acid reflux) in the back of your mouth. The acid can cause the lining of your oesophagus to become inflamed (oesophagitis) or scarred.

What are the benefits of surgery?

You should get relief from symptoms of acid reflux without needing to take medication.

Are there any alternatives to a Nissen fundoplication?

Lifestyle modification is the first line in treatment and can involve avoiding foods that make your symptoms worse, especially late at night. Raising the head of the bed can also help. If you are overweight, it may help to lose weight.

Medication that lowers the acid content in your stomach is effective at controlling symptoms and healing the inflammation in your oesophagus.

Surgery is recommended only if the symptoms continue while you are taking the medication, or if you feel that you would prefer to have an operation than take medication for the rest of your life.

There are surgical alternatives to a Nissen fundoplication such as a partial wrap and placing magnetic beads around your oesophagus (linx procedure).

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes 1 to 2 hours.

Your surgeon will use laparoscopic (keyhole) surgery as this is associated with less pain, less scarring and a faster return to normal activities.

They will make several small cuts on your abdomen so they can insert tubes (ports) into your abdomen. Your surgeon will insert surgical instruments through the ports along with a telescope so they can see inside your abdomen and perform the operation.

They will stitch your diaphragm to reduce the size of the hole your oesophagus passes through.

Your surgeon will wrap and stitch the top part of your stomach around your lower oesophagus, to reproduce a valve effect.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight. Your surgeon may suggest you follow a special diet for the 2 weeks before the procedure to reduce the size of your liver. The liver is a large organ that needs to be lifted to perform the surgery safely. If it is smaller, the risk of complications such as bleeding are reduced.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

Some complications can be serious and can even cause death.

General complications of any operation

• bleeding
• developing a hernia in the scar
• infection of the surgical site (wound)
• allergic reaction to the equipment, materials or medication
• blood clot in your leg
• blood clot in your lung
• chest infection

Specific complications of this operation

Keyhole surgery complications

• damage to structures such as your bowel, liver or blood vessels
• developing a hernia near one of the cuts
• surgical emphysema (a crackling sensation in your skin caused by trapped carbon dioxide)
• gas embolism

Nissen fundoplication complications

• pneumothorax, where air escapes into the space around your lung
• making a hole in your oesophagus or stomach (perforation)
• tear of the stitches used for the wrap
• damage to your liver
• damage to your spleen
• difficulty swallowing for a few months

Long-term problems

• continued difficulty swallowing where you cannot swallow most foods normally
• incomplete control of reflux symptoms
• weight loss
• abdominal discomfort
• diarrhoea
• tissues can join together in an abnormal way

Consequences of this procedure

• pain
• unsightly scarring of your skin

How soon will I recover?

You may be able to go home the same day. However, your doctor may recommend that you stay in hospital a little longer.

You should be able to return to work after a few weeks, depending on how much surgery you need and your type of work.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

You should make a full recovery, with the symptoms of acid reflux gone or much improved.

Summary

Acid reflux can cause heartburn or acid in your mouth. The acid can cause the lining of your oesophagus to become inflamed or scarred. Surgery may be recommended if your symptoms continue while you are taking medication.

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