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Nissen’s fundoplication

Key points

  • Nissen’s fundoplication is an operation that aims to treat the symptoms of gastro-oesophageal reflux disease (GORD).
  • You may be offered this operation if lifestyle changes or medicines haven’t helped your condition.
  • It can be carried out using keyhole or open surgery.
  • You may have side-effects including difficulty swallowing and bloating after a Nissen’s fundoplication.

Pros and cons

  • Pros of Nissen’s fundoplication include not needing to take medicines to treat the symptoms of GORD.
  • Cons of Nissen’s fundoplication include the risk of GORD symptoms returning after the procedure.

Nissen's fundoplication is an operation designed to treat gastro-oesophageal reflux disease (GORD). It may be offered to you if lifestyle changes and medicines haven’t worked.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About Nissen's fundoplication

Nissen's fundoplication is an operation to treat GORD. GORD is a condition in which the contents of your stomach come back up into your oesophagus. Your oesophagus is the pipe that goes from your mouth to your stomach. A muscular valve (sphincter) at the lower end of your oesophagus usually stops your stomach contents from doing this.

The contents of your stomach are acidic and can irritate the lining of your oesophagus if they come into contact with it. This can cause a burning feeling in your chest, called heartburn. GORD occurs when the muscular valve that separates your oesophagus and stomach doesn't work properly.

During Nissen's fundoplication your surgeon will wrap the top part of your stomach around the lower part of your oesophagus to create a new valve. If you also have a hiatus hernia, your surgeon may repair it at the same time. A hiatus hernia is when part of your stomach slides up into your chest through a hole in your diaphragm.

What are the alternatives to Nissen’s fundoplication?

Certain lifestyle changes can improve the symptoms of GORD. These include:

  • stopping smoking
  • losing excess weight
  • reducing your alcohol intake
  • propping up the head of your bed if you mainly get symptoms at night
  • not eating certain foods including chocolate, caffeine and spicy or acidic food

Some medicines can also improve your symptoms. You will probably only be advised to have surgery if medicines aren’t suitable for you. This may be because they don’t control your symptoms, you don't want to keep taking them for rest of your life or they cause side-effects.

Preparing for Nissen’s fundoplication

 Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop. Smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

There are two ways to carry out Nissen's fundoplication. Your surgeon may use keyhole (laparoscopic) surgery or open surgery. He or she will explain your options. See our frequently asked questions for more information.

You will have a general anaesthetic for both keyhole and open surgery. This means you will be asleep during the operation.

If you're having Nissen’s fundoplication, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen. You can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.

What happens during Nissen’s fundoplication?

Nissen's fundoplication takes between one and three hours. If you have a hiatus hernia, your surgeon will probably repair this first. He or she will then wrap the top part of your stomach around the lower end of your oesophagus to make a new valve. This is sewn into place. There are a number of techniques for the procedure but it’s similar whether you have keyhole or open surgery.

Open surgery

Your surgeon will make a single, vertical cut from the bottom of your breastbone to just above your tummy button. Afterwards, he or she will close the skin cut using stitches or staples. Occasionally the operation is done through a cut in your chest, but this is rare.

Keyhole surgery

Your surgeon will make five small cuts in your abdomen and use a laparoscope (a narrow, flexible, telescopic camera) to look inside your body. The camera sends images from inside your body to a monitor, which your surgeon will look at during the operation. Afterwards, he or she will close your skin cuts with stitches – these may be dissolvable.

Occasionally if you’re having a keyhole procedure, your surgeon may need to convert to an open operation for technical reasons.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

How long you need to stay in hospital after your operation will vary depending on what type of procedure you have. You will probably need to stay in hospital for between two and five days if you have open surgery. This is likely to be less if you have keyhole surgery - usually between one and four days.

You may have difficulty swallowing in the first few weeks after your operation. This is normal and is caused by swelling. To help with this, take small mouthfuls of soft or liquidised food and eat slowly. Problems with swallowing usually settle within six weeks.

If your surgeon used clips or non-dissolvable stitches, they will be removed after about seven to 10 days. Dissolvable stitches don’t need to be removed – ask your surgeon how long it will take for them to dissolve.

Your nurse will give you some advice about caring for your healing wounds before you go home. You will be given a date for a follow-up appointment.

Recovering from Nissen's fundoplication

The time it takes to recover after Nissen’s fundoplication varies for everyone, so it's important to follow your surgeon's advice. You will probably recover more quickly if you had keyhole surgery.

If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

What are the risks?

As with every procedure, there are some risks associated with Nissen’s fundoplication. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

These are the unwanted but mostly temporary effects you may get after the procedure, for example feeling sick as a result of the general anaesthetic.

The most common side-effect is difficulty swallowing, which should gradually improve. You may be advised to have a liquid diet at first. Other common side-effects include bloating, abdominal pain, wind and diarrhoea, which should improve within a few weeks but can take as long as six months. You may find that you can't belch or vomit after the operation.

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include the following.

  • An unexpected reaction to the anaesthetic.
  • An infection.
  • Excessive bleeding.
  • Developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

If there are problems during or after a keyhole procedure, your surgeon may need to convert to open surgery. Another possible complication of Nissen's fundoplication is that your stomach, oesophagus or other organs nearby, such as your spleen, could be damaged during the operation.

You may find that the symptoms of GORD come back after the operation. This can happen for a number of reasons including the new valve loosening over time or coming undone, or because you develop a hernia. Putting on a lot of weight can also lead to your symptoms coming back. If this happens, you may need another operation.

It’s possible that if you have very severe problems after Nissen’s fundoplication, you may need to have another procedure. For example, if you continue to have trouble eating solid food or have severe bloating, you may be offered an endoscopy. This involves swallowing a narrow, flexible telescope which is then used to stretch the lower end of your oesophagus.

It’s sometimes necessary to reverse Nissen’s fundoplication but this is a difficult operation to carry out. Your symptoms will return if you have the operation reversed.


Reviewed by Polly Kerr, Bupa Health Information Team, February 2014.

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For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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