About Nissen Fundoplication

Learn about Nissen Fundoplication, a surgical procedure used to correct Gastroesophageal Reflux Disease (GERD) when other medical treatments or lifestyle changes have failed. Nissen Fundoplication is also the initial treatment used to correct a hiatus hernia. Developed by Dr. Rudolph Nissen in 1955, the procedure was not widely used until the 1970s.

What is GERD?

GERD, or Gastroesophageal Reflux Disease, is caused by gastric acid flowing from the stomach back into the esophagus. This occurs when the lower esophageal sphincter (LES) malfunctions, allowing stomach acid and partially digested food to reverse its movement. Under normal conditions, the LES is supposed to close after food passes through it. GERD frequently causes heartburn and, left untreated, may cause ulcers and bleeding in the esophagus. Hiatal hernias are sometimes associated with GERD. A hiatal hernia occurs when a part of the stomach protrudes through the diaphragm. This causes the LES to become weak and malfunction.

How is a Nissen Fundoplication Performed?

In a Nissen Fundoplication, the gastric fundus, or upper part of the stomach is wrapped around the lower esophagus and stitched in place. This strengthens the LES and prevents gastric acid from entering the esophagus. If a hiatal hernia is present, this is also corrected during surgery. Originally performed as open surgery, a Nissen Fundoplication is now usually done laparoscopically. A long incision is replaced with five very small incisions in which a laparoscope and other necessary surgical instruments are inserted to perform the procedure. The laparoscope uses fiber optics to transmit images from inside the body to a video screen.

Healing and aftermath

Improved symptoms are seen in 80 percent of people who have a Nissen Fundoplication and the damage sustained by the esophagus from GERD is healed in 90 percent of patients. After the surgery, 30 percent of patients may still need to take medicine for GERD symptoms. After 7 years, 40 percent of patients may re-experience symptoms of GERD or esophagitis. Resulting in more medication or a second operation.

Nissen Fundoplication is more widely used now than when it was developed in the late 1950s. Technological advances have resulted in changes to how the procedure is performed.