What is a Laparoscopic Fundoplication
The Nissen fundoplication, also performed using laparoscopy (laparoscopic fundoplication), is the surgical intervention to treat Gastro-esophageal Reflux Disease (GERD) and also hiatal hernia. It is the first-line procedure for the treatment of paraesophageal hiatus hernia, after the failure of medical treatment. The Nissen fundoplication is total (360°), but partial fundoplications known as Thal (270° anterior), Belsey (270° anterior transthoracic), Dor (anterior 180-200°), Lind (300° posterior), and Toupet fundoplications (posterior 270°) are the other interventions for various other indications.
Fundoplication is a surgical solution for severe heartburn, acid reflux, or Gastro-Esophageal Reflux Disease. Heartburn develops when the valve between the esophagus and the stomach stops working the way that it should. This allows acid from your stomach to reflux backward, into your esophagus. The esophagus does not have the acid-resistant protective lining that your stomach does, so the reflux of acid causes irritation. Because of this, the acid causes pain that we sense in the upper portion of our stomach or underneath our breastbone.
There are two ways to treat heartburn:
- Decrease the acidity of the stomach so that the refluxed contents do not burn the esophagus. This works well in all but the most severe cases. In severe cases of Gastro-Esophageal Reflux Disease (GERD), there is so much refluxed fluid that even if you reduce the acid content, other substances in the stomach fluid will still irritate the esophagus.
- Repair the Valve – Surgery is clearly the best way to repair the valve. There is a complex anatomic relationship between your diaphragm, esophagus, and stomach that can be restored by performing a Nissen Fundoplication.
Candidates fulfilling the following criteria may need surgery:
- You have discomfort from Heartburn on a daily basis, despite treatment with acid-reducing medications
- You are not obese (your BMI is less than 35)
- You obtain some relief from your acid-blocking medication
Evaluation before surgery requires an Upper GI Barium Swallow and an upper endoscopy procedure. Some patients may also benefit from a pH study of the esophagus and occasionally a pressure (manometry) test.
The rate of complication is only 1 per 1000 patients with a very low mortality rate of 1%.