Possible complications associated with laparoscopic Nissen fundoplication include: Bleeding at the surgical site. Difficulty swallowing (dysphagia) because your stomach is wrapped too high on your esophagus or wrapped too tightly. Difficulty belching.
Structural complications following fundoplication occur in up to 30% of cases and are often related to surgical positioning or construction of the wrap.
The primary risk of Nissen fundoplication surgery is that symptom relief does not always last. Some patients need another surgery after two to three years.
Returning to normal may take a few weeks or months, depending on your body's healing power. Most patients feel much better, and they are able to eat and enjoy life without reflux.
Also known as a Laparoscopic Nissen Fundoplication, this procedure will eliminate your acid reflux symptoms for good. However, it is major surgery and it has its own risks associated with it.
You can do light activity within a couple of days of surgery. You need to avoid heavy activity for 6 weeks. You can drive again when you can confidently make an emergency stop. However, it is a good idea to check with your insurance company when you are covered to drive again.
Nissen fundoplication not only relieves symptoms of acid reflux, but it can also help prevent future complications—even for patients whose acid reflux symptoms are mostly well managed by medications. Oftentimes, these patients are unaware of the long-term effects of GERD.
High rate of recurrence of gastroesophageal reflux has been demonstrated after fundoplication 36 - 38 . In our own experience, we reported almost 50% of reflux after fundoplication alone in obese patients 10 .
The capacity of the stomach is decreased slightly and it doesn't distend as much until healing occurs. On average, our patients lose approximately 10% of their weight. For this reason, it is extremely important for patients to understand their protein and caloric needs following surgery.
Fundoplication surgery, partial or full, creates a one-way valve; Food gets inside the stomach, but stomach content cannot reflux back into esophagus. Consequently, both Nissen and Toupet fundoplications prevent vomiting.
Persistent or recurrent symptoms of reflux and/or persistent postoperative dysphagia are the most common indicators of fundoplication failure (13). Such failures are due to a fundoplication wrap that is too tight, too loose, disrupted, or incorrectly positioned or that has migrated into the chest (1,2,8,13–17).
Limit liquid with meals to ½ cup. Continue to avoid chocolate, nuts and seeds. Avoid- tough meats, strong flavored cheeses, strong seasoning on foods.
Risks of a Nissen fundoplication
All types of surgery have a risk of complications and side effects. Risks of a Nissen fundoplication include injury to the food pipe, stomach, blood vessels or nearby organs. The surgeon might change the procedure to open surgery (when a cut is made in the skin) to repair any damage.
Patients who are elderly, have other health problems, or have weak peristalsis (digestive motion) are not good candidates for a Nissen Fundoplication. In some cases, this surgery may even worsen their condition.
TIF is a less invasive procedure than Nissen fundoplication, the surgery traditionally performed to repair the valve. During Nissen fundoplication, doctors make an incision in the abdomen and then wrap the top of the stomach all the way around the esophagus to re-create a valve. This wrap acts like a tight belt.
Avoid any foods that cause stomach gas and distention. These foods include corn, dried beans, peas, lentils, onions, broccoli, cauliflower and any food from the cabbage family. Avoid carbonated drinks, alcohol, citrus and tomato products.
Another term for the fundoplication is a 'wrap'. This essentially repairs the valve at the end of the esophagus that doesn't work properly in patients with GERD. As opposed to medications for GERD, surgery stops all reflux – digestive enzymes AND acid. Because of this, surgery can cure reflux like medications can't.
Under normal circumstances, most patients after hiatal hernia repair should have a fundoplication. The exceptions being the emergent cases associated the gastric necrosis or the patient in extremis. In patients with good motility, a complete fundoplication is preferable and MSA a viable alternative.
We demonstrated a great response rate of 77.1%, with a mean follow-up of 3.7 years. In this study, we found excellent quality of life after Nissen fundoplication. Nissen fundoplication has been proven effective in reducing GERD and preventing recurrence, even at the long-term follow-up.
Nissen fundoplication or wrap is constructed by suturing stomach to stomach. Full thickness bites are taken on both sides of the stomach to create a durable wrap. Toupet fundoplication, on the other hand, is constructed by suturing stomach to esophagus.
Laparoscopic Nissen Fundoplication is now considered the gold standard surgical approach for treatment of severe gastroesophageal reflux disease (GERD).
Transient dysphagia occurs in 40% to 70% of patients after Nissen fundoplication. This is thought to be secondary to edema at the gastroesophageal junction (GEJ) or transient esophageal hypomotility. Fortunately, dysphagia usually resolves spontaneously within 2 to 3 months.
Just as other body parts, the fundoplication wrap created during the GERD surgery will slowly loosen over time. Therefore even some patients that originally could not burp or vomit will be able to do so as the wrap loosens.
Shortness of breath may result from a slipped Nissen fundoplication, aka recurrent hiatal hernia. Shortness of breath may be precipitated by a heavy meal or gas accumulation in stomach. Obviously, shortness of breath is worse with a larger herniated stomach size.