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Nissen's fundoplication

Published by Bupa's health information team, July 2009.

This factsheet is for people who are having Nissen's fundoplication, or who would like information about it.

Nissen's fundoplication is a procedure to relieve chronic heartburn when it can't be treated with medicine and lifestyle changes.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About Nissen's fundoplication
What are the alternatives?
Preparing for your operation
About the operation
What to expect afterwards
Recovering from Nissen's fundoplication
What are the risks?
Questions and answers
Related topics
Further information
Sources

About Nissen's fundoplication

Nissen's fundoplication is a surgical procedure used to treat severe gastro-oesophageal reflux disease (GORD) and hiatus hernia. GORD is the most common disorder that can affect your oesophagus (the pipe that goes from your mouth to your stomach). GORD is where the contents of your stomach, which are acidic, are brought back up into your oesophagus. When this happens, the acid in your stomach causes a burning sensation in your chest (known as heartburn). In most people with GORD, the valve (sphincter) at the join between the oesophagus and stomach doesn't work properly, allowing this reflux of the stomach acid.

Nissen's fundoplication involves wrapping the top part of the stomach around the lower part of the oesophagus to tighten the valve. If you also have a hiatus hernia (when part of the stomach slides through the diaphragm into your chest), your surgeon will bring the stomach back the original position under the diaphragm. Permanent stitches are used to hold the stomach in place.

What are the alternatives?

Lifestyle changes can help to improve gastro-oesophageal reflux. Stopping smoking, losing weight, and reducing alcohol consumption can all help. Some medicines can also improve your symptoms. However, you will usually be offered surgery if medicines don't improve your symptoms or if you don't want to take long-term treatment.

Preparing for your operation

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 several different Nissen's fundoplication techniques. Your surgeon may use laparoscopic (keyhole) surgery or open surgery. He or she will explain the options available to you.

Nissen's fundoplication usually requires a hospital stay of one to two weeks if you have open surgery, or up to five days if you have laparoscopic surgery. It's performed under general anaesthesia. This means that you will be asleep during the operation.

At the hospital, your nurse may check your temperature, heart rate and blood pressure, and test your urine.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anti-clotting medicine called heparin as well as, or instead of, stockings.

About the operation

Nissen's fundoplication usually takes between 60 and 90 minutes. 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 portion of the oesophagus to make a new valve and sew it into place. Nissen's fundoplication can be done using keyhole (laparoscopic) or open surgery.

Open surgery

A single cut (between six and 10 inches long) is made in the middle of your stomach to perform the operation. Afterwards, the skin cut is closed using stitches or staples.

Keyhole surgery

Your surgeon will make five small cuts on your stomach and will use a laparoscope (a narrow, flexible, telescopic camera) to look inside your body. The camera lens at the end of the laparoscope sends images from the inside of your body to a monitor which your surgeon will look at as he or she performs the operation. Afterwards, the skin cuts are closed with several stitches.

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.

You may have some difficulty swallowing in the first few weeks after your operation. This is normal and is caused by swelling. You will need to take small mouthfuls of food and eat slowly. Your swallowing should return to normal after a month or so.

You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

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.

The amount of time your dissolvable stitches take to disappear depends on the type of stitches you have. They usually disappear in around two to three weeks, but it can sometimes take longer. Non-dissolvable stitches are removed a week after surgery. Please contact the hospital if you have any concerns.

Recovering from Nissen's fundoplication

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.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

Full recovery from Nissen's fundoplication can take up to six weeks.

What are the risks?

Nissen's fundoplication is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

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

The most common side-effect is difficulty swallowing. This should gradually improve after the operation. You will be advised to drink only fluids after the operation and you can begin eating solids two weeks after. Other common side-effects include bloating, abdominal pain, wind and diarrhoea. You may find that you can't belch or vomit after the operation and it's important that you don't drink fizzy drinks.

Complications

This is when problems occur during or after the operation. Most people aren't affected. 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 you're having a keyhole procedure, your surgeon may need to perform an open operation if problems occur. Other complications of Nissen's fundoplication include injury to the oesophagus, stomach, blood vessels and nearby organs, such as the spleen. A hernia can develop in the wound site and may need repairing.

You may find that the symptoms of GORD return if the new valve loosens over time. If this happens, you may need further corrective surgery.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.