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Nissen fundoplication

Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatus hernia. In GERD it is usually performed when medical therapy has failed, but in particular types of hiatus hernia (the paraoesophageal variant), it is the first-line procedure.

History

Dr. Rudolph Nissen first performed the procedure in 1951, and the procedure therefore bears his name.

The procedure

In fundoplication, the fundus (upper part) of the stomach, which is closest to the esophagus, is wrapped around the inferior part of the esophagus and sutured (sewn) there, preventing the reflux of gastric acid (in GERD) or preventing the sliding of the fundus through the enlarged hiatus in the diaphragm.

The procedure can be done laparoscopically (keyhole surgery), and is in fact usually done this way.

Laparoscopic fundoplication has been used safely and effectively in people of all ages, even babies. When performed by experienced surgeons, the procedure is reported to be as good as standard fundoplication. Furthermore, people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.

Although fundoplication is the standard surgical method for treating GERD, it presently is being challenged by endoscopic methods. In 2000, the U.S. Food and Drug Administration (FDA) approved two endoscopic devices to treat chronic heartburn. The Bard Endo Cinch system puts stitches in the LES to create little pleats that help strengthen the muscle. The Stretta system uses electrodes to create tiny cuts on the LES. When the cuts heal, the scar tissue helps toughen the muscle. The long-term effects of these two procedures are unknown.

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Complications

Complications include achalasia, dysphagia (trouble swallowing) and excessive scarring. The procedure can also undo itself over time, leading to recurrence of the symptoms. If the symptoms warrant repeated surgery, the surgeon might decide to use Marlex or another form of artificial mesh to strengthen the connection.

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