The area where the esophagus and stomach meet has a ring-shaped muscle that opens and closes. This muscle is known as the lower esophageal sphincter (LES). When the LES closes it’s like a cap that keeps gastric juices from flowing in the wrong direction. When a person has GERD, the LES weakens. As a result, acid flows up into the esophagus and causes painful symptoms like burning in the chest.
Some people are born with an LES that doesn’t work well. Others may weaken their LES over time because of diet, smoking, and poor body positioning. (Acid tends to move upward if you lie down after a big meal.)
Doctors typically recommend making lifestyle changes, such as improving diet, eliminating alcohol, or losing weight. Antacids and other over-the-counter acid-neutralizing medications may also provide relief. A doctor may prescribe stronger medications such as proton pump inhibitors (e.g., Prilosec) and histamine H2 blockers (e.g., Zantac).
For someone whose acid reflux isn’t responding to standard medical treatment a doctor may recommend Nissen fundoplication surgery.
Nissen fundoplication is a surgical approach to treating gastroesophageal reflux disease (GERD). This surgery, also known as Lap Nissen, aims to strengthen the weakened area of the esophagus that causes stomach acid to flow up instead of down.
Lap Nissen was named after Dr. Rudolf Nissen, the doctor who developed the procedure in the 1950s. Since that time, the surgery has evolved from an open procedure that required large incisions to a laparoscopic (minimally invasive) surgery.
Nissen fundoplication surgery is designed to fix the weak area of the esophagus. The surgery is performed laparoscopically. This means your surgeon doesn’t have to make a big incision to access your esophagus and stomach.
A surgeon starts by making about five small incisions in your stomach. A thin, lighted tube with a camera on the end called a scope will be inserted into the incisions. The camera enables the surgeon to see the inside of your abdomen.
The incisions allow access to the top portion of the stomach (fundus) so it can be wrapped around the bottom of the esophagus. This helps to reinforce the sphincter and prevent acid from coming back up.
The Nissen fundoplication surgery lasts between three and four hours. A hospital stay may last between one and three days, depending on your rate of recovery.
Surgery is usually recommended as a last line of treatment. Most doctors will encourage lifestyle changes first, or prescribe medical therapy to help reduce GERD symptoms. If these options are no longer working or there has been damage to the esophagus or stomach, surgery may be indicated.
You may benefit from Lap Nissen surgery if:
- your prescription medicines for GERD aren't providing relief
- you’ve been taking medications for a long time, and you want a more long-term option
- you’re experiencing scarring or damage such as Barrett's esophagus
- you’re experiencing other side effects from GERD, such as changes to your voice, asthma, coughing, chest pain, or having difficulty eating or drinking
- your quality of life has been affected by your GERD symptoms
A doctor will discuss the risks and benefits with you before scheduling the procedure.
Your doctor will use gas or air to inflate your abdomen to better visualize your stomach before the surgery. This can cause some discomfort after the procedure. To relieve this discomfort, your doctor will likely recommend walking, which can reduce trapped air.
The incisions made during the procedure are small, but there is always the possibility of infection. Your doctor will advise you to keep the incisions clean and dry. You can typically take a shower (but not a tub bath) about two days after your procedure.
Call your surgeon’s office if you experience:
- temperature greater than 101˚F
- incision sites that are swollen, red, hot to the touch, or opening up
- trouble swallowing
- nausea, vomiting, chills, sweating, diarrhea, or constipation
- significant abdominal pain or discomfort
Before going home, your doctor will order a test called a barium swallow study. This test involves swallowing a material containing barium that will react with X-rays. Doctors will be able to see the direction solids and liquids go when you eat or drink something. The barium swallow ensures you aren’t experiencing any complications following surgery.
After your surgery, your doctor will put you on a special diet to help prevent diarrhea, gas, and problems swallowing. You will be allowed to drink clear liquids for your first few meals. Then you will most likely progress to a full liquid diet and then a Nissen soft diet.
Most people who have the Nissen fundoplication surgery report very few complications and an improvement in their GERD symptoms. However, you should call your doctor right away if you develop any new symptoms.