The Nissen fundoplication is the most common anti-reflux operation performed. Gas bloat and inability to vomit after repair may be severe, but infrequently require reoperation; in contrast, other complications can be very debilitating or life-threatening.
This is the name given to the most common operation to stop reflux. The operation helps to prevent vomiting and reflux by “wrapping” the top part of the stomach around the bottom part of the oesophagus. This tightens the oesophagus and prevents backflow of food and stomach acid.
I have found that most of my patients have excellent control of their GERD symptoms with a fundoplication wrap that still allows the majority of them to belch and vomit.
The most common complications are difficulty swallowing, abdominal bloating, diarrhea, and nausea. Most patients can't belch as well as they could before surgery, although the inability to belch is distinctly uncommon. About 25% of patients can't vomit after surgery.
Bloating, abdominal distention, early satiety, nausea, upper abdominal pain, flatulence, inability to belch, and inability to vomit.
Symptoms associated with slipped Nissen fundoplication range from mild chest discomfort to severe heartburn and inability to swallow food.
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.
The number one symptom is any unexplained pain on the abdomen following a hernia operation can be a sign of a failed repair, meaning the patient can have a scar of the previous operation and he can experience a pain on the scar. Rarely, the pain can also happen somewhere away from the original scar.
It's normal to feel full more quickly than usual after your surgery. This is because your stomach is slightly smaller. Eating or drinking too much at once can cause discomfort. This should slowly get better over about 6 to 8 weeks.
However, this is not a normal part of hernia surgery recovery. If you experience any of the following, it could be a sign of hernia mesh complications: Nausea. Vomiting.
Nausea and vomiting can be a common side effect of anesthesia or pain medicine. Nausea and vomiting after surgery can last up to 48 hours.
The mean reported failure after fundoplication is nearly 18% (3-33%) associated with recurrent reflux symptoms or erosive esophagitis, and 4.5-20% of these patients need re-operation 5 , 20 , 21 , 29 , 51 , 52 .
Most are managed within 2 years of the initial operation. Wrap herniation has now become the most common mechanism of failure requiring redo. Redo fundoplication was successful in 93% of patients, and most could be safely handled laparoscopically.
The most common procedure will be a redo laparoscopic Nissen fundoplication. The procedure may need to be done via a laparotomy (an incision in the abdomen) in selected patients. If multiple surgeries have failed, an esophagectomy (esophageal replacement) may be required.
If the procedure is performed improperly, however, the fundoplication can slip down onto the body of the stomach, resulting in recurrent reflux and possible obstruction.
You should be able to progress to a soft-normal diet 4 – 6 weeks after surgery. What is a soft-normal diet? A soft-normal diet involves gradually introducing more solid textures to your diet. While you are having a soft-normal diet you should avoid the same foods you were advised to avoid on page 4.
Avoid crusty breads and sticky, gummy foods, such as bananas, fresh doughy breads, rolls and doughnuts. These types of foods become sticky and difficult to swallow.
The foods to avoid are breakfast cereals with hard dry pieces of fruit or nuts e.g. muesli, bread, muffins, crumpets, bagels, pizza, potato chips, corn chips, raw vegetables, large fruit pips (kiwifruit pips okay) fruit skins, nuts, seeds, popcorn, cooked fibrous vegetables e.g. cabbage, celery, sweetcorn, beans, tough ...
After your first 2 weeks, you can advance to a soft diet. In general this diet is Level 1 plus “anything you can squish through your fingers” but you can also start trying slippery noodles, white fish, minced chicken and soft, cooked vegetables that are chewed well. Take it slowly. Eat small bites, chew well!
Deep breathing and circulation exercises are good. Try to avoid vigorous coughing if your repair was done with the open method. Coughing may strain your incision. For a couple of weeks, when you need to cough or sneeze, splint your incision.
In some cases, you'll often need to continue daily use of the incentive spirometer, and will be on an all-liquid diet. At two weeks: By the time of the first check-up, and depending on the scope of the treatment, most discomfort will start passing (though full results can take up to 10 to 12 weeks).
Returning to normal may take a few weeks or even months, depending on your body's healing power. Most patients feel much better once they are able to eat and enjoy life without a hiatal hernia.
Dumping syndrome may occur when a large volume of gastric content is delivered to the duodenum or jejunum, resulting in both gastrointestinal and vasomotor symptoms. Occasionally, dumping syndrome may be a complication in patients that have undergone nissen Fundoplication, especially in adults.
Children retch following fundoplication because their emetic reflex is activated; it is not because of recurrent gastroesophageal reflux. The presence of the fundoplication markedly impairs expulsion of vomit, so the reflex is not completed and activation is not 'turned off'.