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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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