Laparoscopic Nissen

Laparoscopic Anti-Reflux Surgery:
Gastroesophageal reflux is a common problem that occurs when acid and other juices from the stomach spill back into the esophagus. This can be due to an incompetence of the sphincter/valve mechanism at the junction of the stomach with the esophagus and/or a hiatal hernia where the upper part of the stomach slips into the chest.
Typical symptoms of gastro-esophageal reflux disease (GERD) include:
*heartburn
*belching
*regurgitation of food or stomach fluids causing a bitter and sour taste
*frequently lower chest pain or upper abdominal pain that can be confused with heart or gallbladder disease
These symptoms are usually worse when lying flat. Atypical symptoms can be chronic cough and throat irritation, asthma, vocal chord polyps and accelerated tooth decay.
Complications from untreated GERD are inflammation and ulcers in the lower part of the esophagus which eventually can lead to scarring and narrowing (stricture). The lining of the esophagus can change and look more like stomach or intestine which is called Barrett’s esophagus. This condition has a significantly higher risk of cancer and requires careful observation.

Treatment Options:
Treatment can be medical/conservative or surgical. Usually medical treatment is initiated first and consists of lifestyle changes such as elevation of the head of the bed, avoiding alcohol, smoking, coffee, as well as spicy and greasy food. The mainstay of the medical treatment of reflux are the proton-pump inhibitors (PPI), a class of medications that very effectively decreases acid production in the stomach and relieves the symptoms in most patients. However, these medications do not cure the actual reflux which is a mechanical problem. The reflux still occurs and is just less caustic.
Reasons to consider an operation for GERD include:
*failure of medical therapy with persistent symptoms
*severe esophagitis
*Barrett’s esophagus
*large hiatal hernia
*unwillingness of young patients to take PPI medication permanently
The required work-up before considering an operation consists of upper endoscopy (EGD) and esophageal manometry. Depending on the circumstances a 24 hour pH study and a Barium swallow study may also be necessary.

The Operation:
The most commonly performed procedure for GERD is a “Nissen” fundoplication. During this operation the upper part of the stomach (fundus) is used to create a wrap around the lower part of the esophagus which effectively reestablishes a valve mechanism at the gastro-esophageal junction and prevents reflux from reoccurring. In the vast majority of cases this operation can be performed laparoscopically, i.e. through small holes with a camera instead of a large incision. This results in less pain, faster recovery, earlier return to normal activities and significantly shorter hospital stays.

Recovery from the Operation:
Most patients can go home the next morning but should avoid heavy lifting or strenuous work for about three weeks. As with any laparoscopic operation there is always a small chance (<1%) that the procedure can not be safely completed and may have to be converted to an open operation. Other possible complications include bleeding, infection, difficulty swallowing, which is usually temporary, injury to stomach, esophagus, liver, spleen or diaphragm. Due to expected swelling of the wrap most patients experience various degrees of swallowing difficulty (dysphagia) postoperatively and will be on a liquid or very soft dietfor the first two weeks and then gradually advance their diet to solid food. Longterm complications after a fundoplication can be recurrent reflux, persistent dysphagia, slippage of the wrap into the chest (paraesophgeal hernia), inability to burp and vomit.

Alternatives to Surgery for Reflux:
Other procedures for GERD ,especially endoscopic manipulations have been developed but are at this time experimental and not sufficiently tested to be recommended for general use.

---

Please Note:Information at this web site is for general information and is not intended for diagnostic or therapeutic treatment. The information is provided on a voluntary basis by Southern Surgical Associates, PA for general information purposes. Southern Surgical Associates, PA does not warranty the accuracy of the information. Persons should contact their own physician for appropriate care and treatment of their health.