Laparoscopic Nissen Fundoplication
Nissen fundoplication 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 Long Island Minimally Invasive Surgery, patients benefit from the expertise
of two of the leading laparoscopic surgeons with extensive experience and
expertise in the field.
Advantages of the Laparoscopic Nissen Procedure
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 video camera,
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, Dr. Garber 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, Dr. Garber repairs the hernia before proceeding
with the wrap.
Following the operation, surgical tape or stitches close the incisions.
Before Surgery
Not all patients with heartburn need or can benefit from Nissen fundoplication.
Before the procedure is recommended, Dr. Garber 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, Dr. Garber will discuss the benefits,
risks, and possible complications of the operation.
Your Recovery
In the hours following the operation, you will experience some pain from the
small incisions your surgeon made to perform the procedure. After one or two
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. Dr. Garber will, however, 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.
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