Laparoscopic Nissen Fundoplication

Nissen fundoplication (NIS sen FUN do pli KA shun) is a procedure that alleviates chronic heartburn in people whose condition cannot be controlled by either lifestyle changes or medication. Their symptoms are caused by severe gastroesophageal reflux due to a weak valve muscle between the stomach and the esophagus. They experience a burning sensation from the chest to the throat whenever stomach acids are forced back up into the esophagus.

If you are one of these people, Nissen fundoplication offers a good chance of overcoming a condition that affects many areas of life-from what and when you eat, to how well you sleep and what you wear. In fact, a recent study found that 90 percent of patients undergoing the procedure are symptom-free after 10 years. However, because laparoscopic Nissen fundoplication requires extensive and highly specialized training, only a few surgeons in the United States perform the procedure.

At Penn State Milton S. Hershey Medical Center, patients benefit from the expertise of a leading laparoscopic surgeon and the latest laparoscopic surgery technology. Highlights include three dimensional imaging, the most advanced ultrasound equipment currently available, and new internal laparoscopic suturing instruments.

First performed by Dr. Rudolph Nissen in 1951, Nissen fundoplication has traditionally been performed as an open surgery procedure requiring an incision of 6 to 10 inches long. Patients were normally hospitalized for about 10 days, and recuperation required up to two months. Because of the large abdominal incision, recovery entailed significant pain.

Today, however, Nissen fundoplication can be performed laparoscopically. Because the new approach requires only five small incisions, patients experience minimal pain and recover faster. The laparoscope, which is a telescopic videocamera, gives a better view of internal organs than can usually be achieved in a traditional open procedure. Magnified images viewed on the video monitor reveal internal structures, including blood vessels, in exquisite detail.

Patients lose less blood during laparoscopic surgery than during traditional surgery, and they experience fewer infections and other complications as a result of surgery. In a week or two, patients can return to work.

Strengthening the Stomach Valve

Whether Nissen fundoplication is accomplished traditionally or laparoscopically, the procedure is the same. To prevent stomach acids from being forced back into the esophagus, your surgeon must strengthen the "valve" between the stomach and the esophagus. He accomplishes this by wrapping the upper portion of the stomach, or fundus, around the bottom of the esophagus.

About 40 percent of all patients needing Nissen fundoplication have hiatal hernias, a condition that contributes to the burning sensation that patients may experience in their chest, throat, and jaw. Although this condition alone cannot cause gastroesophageal reflux, the surgeon repairs the hernia before proceeding with the wrap.

Following the operation, surgical tape or stitches close the incisions.

In a small percentage of cases-about one in 50 (about 2 percent) - the surgeon is unable to complete the Nissen fundoplication laparoscopically, and must revert to the open procedure.

Not all patients with heartburn need or can benefit from Nissen fundoplication. Before the procedure is recommended, your physician will carefully evaluate your condition. This may require a sensitive test that monitors your heartburn over a period of time. If the procedure can help, your physician will discuss the benefits, risks, and possible complications of the operation.

A pre-admission evaluation, including routine blood testing, is completed within five days of the procedure. It provides your surgeon with important information about your health before the operation.

You will be admitted to the hospital the day before or the same day as your surgery. Before the operation, an anesthesiologist will meet with you.

Because laparoscopic Nissen fundoplication is performed under general anesthesia, you cannot eat or drink anything after midnight the day before the surgery.

In the hours following the operation, you will experience some pain from the small incisions your surgeon made to perform the procedure. After three or four days, you can expect to return home, where you will be able to take care of yourself.

Within a week or so of leaving the hospital, you can resume your normal schedule, including returning to work. You can also resume fitness programs and sports competition. Your surgeon, however, will place you on a soft foods diet for up to three weeks following surgery.

The surgical incisions will be barely visible a few months after the procedure.