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Laparoscopic Nissen Fundoplication

Laparoscopic Nissen fundoplication is a minimally invasive procedure which is done to restore the function of the lower esophageal sphincter (the valve between the esophagus and the stomach) by wrapping the stomach around the esophagus. This procedure creates a new “functional valve” between the esophagus and the stomach and prevents reflux of the acid and bile (non-acidic fluid) from the stomach into the esophagus. It is well studied that patients with typical (common) symptoms of gastroesophageal reflux disease – heartburn, regurgitation and dysphagia (difficulty swallowing) – who respond well to antacid therapy and have a positive esophageal pH assessment (evidence of acid in the esophagus) have the best outcome after laparoscopic Nissen fundoplication.

The steps of the operation are as follows:

Five small incisions are made in the abdomen where a camera and working surgical instruments are placed, as shown in the following images.

Incisions for Laparoscopic Nissen Fundoplication

Larparoscopic Myotomy 2

The esophagus is mobilized and the opening in the diaphragm (crural opening) is identified.

Larparoscopic Myotomy 4

The crural opening is then closed.

Larparoscopic Myotomy 6

The fundus (upper part of the stomach) is then wrapped around the lower portion of the esophagus.

Larparoscopic Myotomy 8

The fundoplication is formed by suturing the stomach around the esophagus.

Larparoscopic Myotomy 6

Video: Laparoscopic Nissen Fundoplication

Following surgery, patients stay in the hospital for one night. They start drinking one day after surgery and are discharged home. They will follow dietary restrictions for about two weeks and can start advancing their diet after the clinic visit two weeks after surgery. This procedure is routinely performed at the Memorial Hermann Southeast Esophageal Disease Center for the treatment of patients with gastroesophageal reflux disease.

References

1. Campos GM, Peters JH, DeMeester TR, Oberg S, Crookes PF, Tan S, DeMeester SR, Hagen JA, Bremner CG. Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg 1999;3:292-300.

2. Epidemiology of gastro-oesophageal reflux disease: a systematic review Gut 2005;54:710-717

3. Farzaneh Banki, Tom R DeMeester. Treatment of complications of gastroesophageal reflux disease and failed gastroesophageal surgery. Oesophagogastric Surgery, A Companion to Specialist Surgical Practice: Michael Griffin, Fourth Edition, 2009, page 281-292

By Farzaneh Banki, M.D.