Laparoscopic Nissen Fundoplication is now considered the gold standard surgical approach for treatment of severe gastroesophageal reflux disease (GERD).
The entrance to the stomach consists on a muscle called lower esophageal sphincter or “LES.” The LES closes as soon as food passes through, however when the LES doesn’t close all the way or opens often stomach acid can travel back up into the esophagus. This occurrence is known as Gastroesophageal reflux disease or GERD.
During a Nissen fundoplication operation, the esophageal hiatus (a hole in the diaphragm through which the esophagus passes) is usually narrowed down by sutures first to prevent or treat a concurrent hiatal hernia. Then the upper portion of the stomach (fundus) is wrapped around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter.
Who should consider Anti-Reflux Surgery?
Those who:
- Have inadequate symptom control despite high dose of medications.
- Have medication side effects have complications of GERD such as Barrett’s esophagus or stricture.
- Have extra-esophageal manifestations (asthma, hoarseness, cough, chest pain, aspiration)
- Chose to have surgery to avoid lifelong acid suppression medications or to improve quality of life
Studies have strongly supported surgery as an effective alternative to acid suppression medications. Long-term follow-up data showed that surgery resulted in significantly less acid exposure and significantly increased lower esophageal sphincter pressure compared with medical therapy. Surgery has also been demonstrated to lead to high patient satisfaction rates. The majority of patients can stop acid suppression medications after surgery.
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