Gastroesophageal Reflux Disease (GERD) is a chronic severe heartburn. In cases where treatments such as medication, weight loss and improved diet have not succeeded in controlling the disorder, GERD can be corrected using the minimally invasive procedure known as laparoscopic Nissen fundoplication to rebuild the connection between the stomach and the swallowing tube (esophagus).
GERD is far different from common heartburn, an occasional complaint that is normally relieved by over-the-counter remedies. Advanced GERD can lead to ulcers, internal scarring, and even cancer.
One successful form of surgery to prevent further injury to the esophagus is the Nissen fundoplication, named for the surgeon who pioneered the procedure. The operation consists of a plication (wrapping or folding) of the fundus (part of the stomach) around the lower end of the esophagus.
Nissen fundoplication can be done in most cases today as a microsurgical procedure involving only small incisions, minimal pain and blood loss, and rapid recuperation. Patients normally return to active life in about two weeks.
With the patient under general anesthesia, small incisions are made in the abdomen, including one to admit the laparoscope or microcamera, which affords the surgeon a magnified, detailed view of the affected areas. If necessary, the surgeon first applies sutures to tighten the hiatus (opening) in the diaphragm, in order to stabilize the stomach and lower esophagus.
In the main operation, the adjacent portion of the stomach is wrapped once around the esophagus and sutured in position, creating a one-way valve that allows food to pass into the stomach while preventing gastric contents from backing up in the other direction.
The length of hospitalization required for laparoscopic Nissen fundoplication is typically 3-4 days with a return to normal activities in as little as two weeks.
Traditional Nissen fundoplication is an open surgery procedure requiring an incision 6 to 10 inches long. The hospital stay is about 10 days. Recovery is more painful on account of the large scar, requiring as long as two months.
Surgical therapy has a high success rate in improving sphincter function. The Nissen fundoplication is perhaps the most widely performed procedure as it has the best results, with 85-90% of patients reporting improvement of their symptoms. The downside to all of these surgical procedures is that about 10% of patients will have recurrence of their GERD symptoms within a year.
Last updated: 01-Apr-03