Lap Nissen, is a laparoscopic procedure performed for patients with gastroesophageal reflux disease (GERD). Many patients with reflux can be treated with medicines to decrease acid production in the stomach. This will minimize the damage to the esophagus from acid refluxed up from the stomach, and allow the esophagus to heal. However, some patients continue to have symptoms of either regurgitation or incomplete healing of their esophagus despite medical therapy. These patients should consider surgery as another option.
If this sphincter mechanism fails, acid is free to reflux up into the esophagus causing damage. Surgery basically repairs the hiatal hernia and recreates this lower esophageal sphincter by wrapping a portion of the stomach known as the fundus around the lower esophageal sphincter. This procedure will prevent further reflux and eliminate the need for long term medical therapy.
Pre-procedure workup may consist of a barium swallow or endoscopy to access the severity of reflux. Other investigations include esophageal manometry. Occasionally, a 24 hr. pH monitor is needed. which measures the pressures generated within the esophagus with swallowing. Certain conditions within the esophagus can mimic reflux disease but are treated in an entirely different way.
The laparoscopic procedure requires placement of two 10mm holes (ports) and three 5mm holes (ports). The entire procedure takes about 1 hour. The vast majority of procedures are performed outpatient. There is minimal restrictions to activity and most patients are able to return to work in a couple days. The patients are able to stop all their reflux medications and are able to lie flat in bed, enjoy meals at late hours, etc. which they were not able to do before.
During a Nissen fundoplication, the topmost part of the stomach is wrapped around the lowest part of the esopagus.
Transient dysphagia occurs in 40% to 70% of patients after Nissen fundoplication. This is thought to be secondary to edema at the gastroesophageal junction (GEJ) or transient esophageal hypomotility. Fortunately, dysphagia usually resolves spontaneously within 2 to 3 months.
Generally, a liquid diet for the first week. Avoid caffeine, carbonated drinks, alcohol, citrus and tomato products. You will then advance to a soft diet slowly?
Laparoscopic Nissen fundoplication is a safe and effective treatment for refractory esophageal reflux and its complications and has the extra benefit of reduced hospital cost and stay and a more rapid return to work.
Laparoscopic fundoplication is the gold standard for surgical treatment of severe GERD and results in approximately 95% patient satisfaction.
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