Published by Bupa's Health Information Team, October 2011.
This factsheet is for people who are having Nissen's fundoplication, or who would like information about it.
Nissen's fundoplication is an operation to treat heartburn when medicines and lifestyle changes 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.
Nissen's fundoplication is an operation to treat severe gastro-oesophageal reflux disease (GORD). GORD is when the contents of your stomach, which are acidic, are brought back up into your oesophagus (the pipe that goes from your mouth to your stomach). The acid causes a burning feeling in your chest, called heartburn. GORD usually happens because the valve (sphincter) at the join between your oesophagus and stomach doesn't work properly.
During a Nissen's fundoplication your surgeon will wrap the top part of your stomach around the lower part of your oesophagus to tighten the valve. If you also have a hiatus hernia, which is when the upper part of your stomach slides through the diaphragm into your chest, your surgeon may repair it at the same time.
Making lifestyle changes, such as stopping smoking, losing weight and reducing your alcohol intake, can improve GORD. Some medicines can also improve your symptoms. Your doctor will only suggest surgery if medicines don’t control your symptoms, you don't want to keep taking them for rest of your life, or they cause side-effects.
Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as 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.
You will usually need to stay in hospital for five to eight days if you have open surgery, or for up to five days if you have keyhole surgery. You will have a general anaesthetic, which 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, and 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, which you may be asked to do by signing a consent form.
Nissen's fundoplication can take up to two and half hours. If you have a hiatus hernia, your surgeon will 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, and sew it into place.
Your surgeon will make a large single cut in the middle of your abdomen (tummy) to carry out the operation. Afterwards, he or she will close the skin cut using stitches or staples.
Your surgeon will make five small cuts on 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 the skin cuts with stitches.
You may 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.
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 food and eat slowly. Your swallowing should return to normal after a month or so.
The amount of time your dissolvable stitches take to disappear depends on the type of stitches you have. However, for this procedure, they should usually disappear in about 10 days. Non-dissolvable stitches are removed a week after surgery.
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.
It usually takes about six weeks to recover completely from Nissen’s fundoplication, but this varies between individuals, so it's important to follow your surgeon's advice.
If you need pain relief, you can take over-the-counter medicines, 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.
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.
These are the unwanted but mostly temporary effects you may get after having 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 will be advised to have a liquid diet for a week or so after your operation and then eat soft foods for a week or two. Other common side-effects include bloating, abdominal pain, wind and diarrhoea, which can last for two weeks. You may find that you can't belch or vomit after the operation.
Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or 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 switch to an open operation. Other complications of Nissen's fundoplication include damage to your oesophagus, stomach, blood vessels and nearby organs, especially the spleen. You may find that the symptoms of GORD come back if the new valve loosens over time or comes undone, or if you put on a lot of weight. If this happens, you may need another operation.
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.
Publication date: October 2011