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Nissen Fundoplication is used to treat severe Gastro-oesophageal Reflux Disease (GERD) when medications fail to provide adequate relief. It works by wrapping the fundus (upper part of the stomach) around the lower oesophagus to strengthen the anti-reflux barrier between the stomach and oesophagus. Large hiatal hernias, medication-resistant persistent GERD, and reflux-related problems such oesophagitis (inflammation), Barrett's oesophagus (in certain cases), oesophageal strictures (narrowing), and reflux-related chronic cough or recurrent aspiration are frequently advised.
Consult your doctor if you have severe heartburn despite long-term medication use, regurgitation of food or acid, dysphagia (difficulty swallowing), persistent cough or worsening asthma due to reflux, reflux-related chest pain after cardiac causes are ruled out, frequent hoarseness or throat discomfort, and complications such as reflux ulcers or Barrett's oesophagus.
Prior to surgery, patients undergo a clinical assessment and medical history review, followed by investigations such as upper gastrointestinal endoscopy, 24-hour pH monitoring, oesophageal manometry, and barium swallow study in select cases, as well as routine tests such as LFT, RFT, CBC, chest X-ray, and ECG. Before surgery, patients are recommended to abstain from alcohol and tobacco, stop taking blood thinners (if prescribed), and fast for six to eight hours.
Nissen fundoplication is typically carried out laparoscopically under general anaesthesia. The surgeon makes tiny keyhole incisions, repairs any hiatal hernia, and then completely wraps the fundus (upper portion of the stomach) around the lower oesophagus to strengthen the anti-reflux barrier. The incisions are closed while the patient is monitored, and the wrap is secured to prevent reflux.
Usually, the procedure takes one to two hours. The duration of surgery can also differ based on the patient's anatomy, past abdominal procedures, and the existence of comorbidities.
Nissen fundoplication is safe, but there are a few potential risks:
- Infection and bleeding
- Initial difficulty swallowing (temporary dysphagia)
- Gas-bloat syndrome (increased bloating, trouble belching)
- Vomiting or nausea
- Failure or loosening of the wrap (rare)
- Symptoms of reflux returning
- Damage to the spleen, oesophagus, or stomach (rare)
- Risks associated with anaesthesia
Fundoplication provides multiple benefits, including long-term relief of GERD symptoms, a reduction in the requirement for long-term acid-suppressive drugs, increased quality of life, prevention of reflux-related oesophageal injury, and better control of aspiration symptoms and persistent cough.
Postoperative recovery usually comprises a one to three-day hospital stay, as well as breathing exercises and early walking to aid with recuperation. Over the course of several weeks, a structured dietary progression is followed, progressing from liquids to a soft diet and finally to a regular diet.
Nissen fundoplication has a high success rate; 85–95% of patients attain symptom control, and in carefully selected situations, the long-term results are outstanding. Overall outcomes are mostly determined by the surgeon's experience and skill as well as a thorough pre-surgical assessment.
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+99Process Involved for Nissen Fundoplication
- GERD diagnosis and severity assessment
- Testing prior to surgery (manometry, pH monitoring, endoscope)
- Planning for surgery
- Method (fundoplication ± correction of a hiatal hernia)
- Recuperation after surgery and diet advancement
- Monitoring to manage reflux symptoms
- Severe GERD
- Reflux with hiatal hernia
- Esophageal reflux
- Barrett's oesophagus (in certain instances)
- Aspiration or coughing due to reflux
- Laparoscopic Nissen Fundoplication (the most common).
- Nissen Fundoplication is open.
- Fundoplication with robotic assistance
- In certain situations, partial fundoplication (Toupet/Dor)
In {country}, for medical treatment:
- Verifiable proof of identity (passport or visa for foreign patients)
- Diagnostic reports (manometry, pH analysis, endoscopy)
- Consent forms for anaesthesia and surgery
- Documentation related to insurance (if appropriate)
Patients may be eligible if:
- Despite taking medication, GERD symptoms continue.
- The patient has Barrett's changes, strictures, and oesophagitis as reflux consequences.
- There is a large hiatal hernia.
- The patient would rather have surgery than take medication for life.
- The patient is ready for surgery and anaesthesia.
- Hiatal hernia repair
- Endoscopy (follow-up and diagnostic)
- Dilatation of the oesophagus (if stricture is present)
- Long-term or permanent management of reflux
- Oesophagitis healing
- Decreased long-term GERD complications
- Reduced reliance on acid suppressants
After a successful fundoplication
- Regurgitation and heartburn considerably lessen
- Reflux lessens at night.
- After the initial recuperation, swallowing gradually gets better.
- Better quality of life and sleep
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