Gastroesophageal reflux disease (GERD) is a chronic digestive disease that occurs when stomach acid or, occasionally, bile flows back (refluxes) into your food pipe (esophagus). The backwash of acid irritates the lining of your esophagus and causes GERD signs and symptoms that are generally referred to as heartburn. In addition to heartburn symptoms, severe GERD can also cause problems with worsening asthma, recurrent pneumonia, or chronic laryngitis. The treatment for GERD is usually begun with lifestyle modification and diet changes. When this is insufficient, medications can be added to manage the symptoms. For some patients these treatments might not be enough and surgery may be indicated.
The laparoscopic Nissen fundoplication is the standard operation to treat severe GERD that is not controlled with medications. In general, the top of the stomach is wrapped around the lower esophagus in order to reinforce the valve at the end of the esophagus that limits reflux of stomach contents back into the esophagus. Therefore, it is called an “anti-reflux” procedure. In general, 90% of patients who have this operation can expect to have good improvement in their heartburn symptoms and be able to stop using medications.
- The indications for a Nissen Fundoplication procedure include:
- Patient who does not want to take medicine for life
- Patients who are allergic to proton pump inhibitor (PPI) medications
- Patients who develop resistance to PPI medications
- Patients who develop complications from GERD despite taking PPI medications. (ie. bleeding, ulcers, strictures)
- Patients who have proximal reflux complications. (ie. asthma, hoarseness, pneumonia)
Revision Nissen fundoplication:
There is a small sub-group of patients who undergo Nissen fundoplication for GERD who initially do well and then experience recurrent symptoms or complications because of a recurrent hiatal hernia or having the wrap slip down onto the stomach. These patients are candidates for a laparoscopic revision procedure to address their issues.