Laparoscopic Nissen Fundoplication
What is gastroesophageal reflux disease (GERD)?
Gastroesophageal reflux disease (GERD) involves a problem with the lower esophageal sphincter (LES). The LES is located at the lower end of the esophagus. Normally, the LES acts as a one-way valve, allowing contents to pass from the esophagus into the stomach. When there is a problem with the LES, stomach contents can "come back up" into the esophagus. This is called reflux. Because stomach contents are acidic in nature, this reflux causes a burning sensation often called "heartburn".
What are some treatment options for GERD?
The treatment for GERD involves three areas: lifestyle changes, drug therapy and surgery. Lifestyle choices that improve GERD are weight loss, smoking cessation, reduced alcohol intake and a low fat, low caffeine diet. Drug therapy includes over-the-counter antacids and prescription medications such as Prilosec, Zofran and Propulsid. Surgery becomes an option when the other two treatment options become ineffective or otherwise prohibitive.
What is a laparoscopic nissen fundoplication?
When surgery is required for GERD, it is performed by using the upper part of the stomach (the fundus) to reinforce the lower esophageal sphincter. This surgical procedure is called a fundoplication. A fundoplication can be performed as an open procedure or as a laparoscopic surgery. A laparoscopic nissen fundoplication means that a surgeon will use several small incisions, use special instruments, and, with the aid of a videoscope and TV monitors, will perform the fundoplication.
What are the benefits of a laparoscopic nissen fundoplication versus an open fundoplication?
Compared with open fundoplication, laparoscopic fundoplication reduces the hospital stay and recovery period, decreases postoperative pain and leaves less noticeable scars.
Will I need any tests before surgery?
Your doctor may order an upper endoscopy, a 24-hour pH monitoring and an esophageal motility study. Blood work may be ordered.
How should I prepare for my surgery?
The evening before your surgery, a nurse will call and tell you what time to come to the hospital and where to register. The night before your surgery, do not eat or drink anything after midnight. The morning of your surgery, do not smoke or chew tobacco or gum. Bring any comfort items from home that you may need for a brief hospital stay.
How long will I be in the hospital? When will I be able to return to work?
You will stay in the hospital one to three days. Occasionally, some patients stay longer. You will be able to return to work within two to three weeks.
What should I expect after surgery?
- You will be on a clear liquids diet and advanced as tolerated to soft, pureed foods.
- If you become nauseated, notify your nurse.
- The nurse will teach you how to cough without damaging your surgical site or incision.
- Do not lift heavy objects (groceries, vacuum cleaners, etc.) or exercise without your doctor’s approval.
- You may walk as often as you can. Walking will help you recover faster.
- You will be given important information regarding your diet.
- While in the hospital, a dietitian will visit you to discuss your diet and dietary needs.
- Gradually, your diet will progress from fluids to pureed foods, to minced and soft foods, then to solid foods.
- Eat several small meals a day. Eat only until you are full.
- As long as you are not having problems, you can increase the amount of food every two days.
- Eat slowly and chew your food well.
- Drink plenty of fluids with your meals. Try alternating a bite of food with a drink of fluids.
- Avoid carbonated sodas, caffeine and very cold drinks.
- You may add spices to your food as tolerated.
- Sit upright when you eat and remain upright for at least 20 minutes after eating. This aids digestion and decreases gas forming in the stomach.