How long does nissen fundoplication last

They will receive special instructions on how to care for their surgical wounds. This often includes not bathing for the first days after being discharged, regularly changing the dressings on wounds, and washing the wounds with gentle soap. People will need to follow a special diet after fundoplication, as the stomach needs time to heal.

They may need to receive food through a gastrostomy tube. In these cases, a doctor will go over the process with the patient, and they will arrange for the supplies and food to be sent to their house. After this, it may be safe to gradually introduce regular foods again.

This often includes working with a specialist to introduce soft foods at first, moving to solid foods with time. During the recovery period, it is important to work with a doctor or dietitian to ensure that the diet contains enough nutrients. Although fundoplication surgery can help people control acid reflux and ease the symptoms, side effects are common. For instance, a full degree fundoplication helps with the symptoms of reflux, but it also makes it difficult for the sphincter to open at other times to release pressure.

If a doctor or a patient has concerns about side effects from increased gas, they may choose an alternative procedure, such as the or degree fundoplication. One meta-analysis found that both the degree and degree fundoplication procedures have similar success rates when it comes to controlling symptoms.

People who had degree fundoplication had fewer side effects just after the surgery, but the risk of side effects from both surgeries tended to even out with time. Also, it is important to note that surgery is not permanently effective in every case. People who already experience gas or pain from bloating should discuss alternative options with their doctor beforehand. Fundoplication is the standard surgical treatment for GERD in people whose bodies do not respond well to medical treatment or home remedies.

Some people may experience both short- and long-term complications, such as increased gas in the abdomen. Fundoplication surgery is not a replacement for other treatment methods. Doctors will likely still recommend making dietary and lifestyle changes to help control symptoms, and they may also recommend taking medications to support these changes. Surgery for treating GERD involves closing off or narrowing the lower end of the esophagus to prevent acid reflux.

Learn more about the options here. Acid reflux is a common condition that causes discomfort. This article lists easy, inexpensive remedies a person can try at home. This article discusses over-the-counter treatments for GERD, how they work, and their side effects. It covers H2 blockers, antacids, and more. What is Fundoplication? This is of particular relevance to laparoscopic antireflux surgery because the introduction of this new technique was associated with unexpected complications, such as an increased incidence of paraesophageal hiatus herniation.

Hence, we cannot be certain that long-term results can be extrapolated from short- to medium-term follow-up. The long-term outcome for open Nissen fundoplication has been reported previously. Long-term data is provided by various Scandinavian series. To achieve a minimum of 5 years' follow-up for laparoscopic Nissen fundoplication, we attempted interviews with every patient who underwent this procedure between September and July , generating a series of laparoscopic Nissen fundoplications.

We previously reported that there is a learning curve for this operation; the results of a surgeon inexperienced with this procedure are associated with a poorer outcome, a higher conversion rate, and a higher reoperation rate. Selectively omitting this group, who tended to be less satisfied with the outcome of their original procedure, could artificially enhance the quality of the overall outcome, and this should be avoided.

Reoperation for paraesophageal hiatus herniation was common initially, and we have discussed this in detail elsewhere. Since routinely narrowing the hiatus, the problem of postoperative herniation is now much less common. Similarly, the issue of a tight hiatus caused by fibrosis has become infrequent as we have made adjustments to our surgical technique. Postoperative dysphagia is often difficult to assess because the outcome reported depends on who asks about it eg, surgeon vs independent investigator , how the questions are constructed, and the scoring system used.

For this reason, it is better to consider data that compare the same patients at different time intervals as we have done here or comparative data from randomized trials. Within the current study, it is clear from Figure 1 that the incidence and severity of dysphagia with liquids was not influenced by laparoscopic Nissen fundoplication and that the number of patients with severe dysphagia with liquids at 5 years was less than the number reporting this problem before surgery.

For dysphagia with solid food, there were also less patients with severe dysphagia 5 years after surgery than before surgery. However, more patients reported minor dysphagia with solids at 5 years follow-up than before surgery, and this was caused by an increase in the number of patients with mild dysphagia with solids.

Although severe dysphagia was less common, there were more patients overall with dysphagia after surgery, even though it was not usually troublesome and did not require any dietary modification. Of importance for the assessment of laparoscopic Nissen fundoplication is its ability to abolish reflux symptoms, particularly heartburn.

The outcomes are similar to those following open Nissen fundoplication, suggesting that the laparoscopic approach does not compromise reflux control.

However, our follow-up is clinical only, and objective follow-up using either pH or endoscopic studies was not sought. It is certainly possible that a few patients who claimed relief of reflux symptoms might demonstrate abnormalities if they underwent either pH monitoring or endoscopy. On the other hand, some of the patients who claimed to experience symptomatic reflux following surgery had no objective evidence of reflux when they underwent postoperative testing.

For this reason, in a clinical practice setting, the symptoms experienced by patients ultimately determine the success or failure of the operations we perform, not the outcome of follow-up tests or the surgeon's opinion about technical success. Hence, we believe that laparoscopic Nissen fundoplication is an effective long-term treatment for gastroesophageal reflux disease, yielding similar results to open fundoplication but with the short-term advantages of quicker recovery and reduced wound-related morbidity.

Corresponding author: David I. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Figure 1. View Large Download.

Am J Surg. Anvari MAllen C Laparoscopic Nissen fundoplication: two-year comprehensive follow-up of a technique of minimal paraesophageal dissection. Ann Surg. DeMeester TRBonavina LAlbertucci M Nissen fundoplication for gastroesophageal reflux disease: evaluation of primary repair in consecutive patients.

Br J Surg. Fate of Nissen fundoplication after 20 years: a clinical, endoscopical, and functional analysis. Dig Dis Sci. Value of Nissen fundoplication in patients with gastro-oesophageal reflux judged by long-term symptom control. Laparoscopic or conventional Nissen fundoplication for gastro-oesophageal reflux disease: randomised clinical trial. Prospective double-blind randomised trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels.

Aust N Z J Surg. Moreover our aggressive follow-up protocols by routine postoperative pH metry and endoscopic control would explain higher recurrence rates as regards studies [ 17 ].

We found that while obese patients had similar short outcomes than other patients obese patients had a higher failure rate after follow-up of 11 years or more. The precise mechanism by which obesity adversely affects the durability of antireflux operations is not clear. Antireflux operations can fail from loosening of the fundoplication, slippage of the repair, or migration of the wrap into the chest [ 38 — 42 ].

Fixation of the fundoplication to the undersurface of the diaphragm seems less effective in preventing this complication than thorough esophageal mobilization and crural closure [ 42 ]. The crural closures were not routinely closed in our study, but the fundoplication herniation occurred only in obese patients.

The data in our study does not provide a mechanistic reason for the failure of antireflux operations due to obesity. The esophageal hiatus is a very dynamic area, moving with each breath and each swallow. We can only theorize that increased intra-abdominal pressure in obese patients augments the usual wear and tear on the surgical repair and contributes to loosening of the crural closure and fundoplication. Moreover a variety of mechanisms have been described that likely contribute to the association of GERD and obesity.

Presence of these alterations in obese patients should furthermore clarify not excellent results in patients in which fundoplication was performed. In our study we observed the same result. Therefore we agree with authors who affirm that for obese patients suffering from GERD weight loss in conjunction with antisecretory medications is first-line therapy [ 49 ].

Indeed, evidence supports the role of weight loss as a beneficial therapy for reflux symptoms [ 50 , 51 ]. When medical efforts to lose weight fail, bariatric surgical procedure are considered laparoscopic adjustable gastric band; vertical banded gastroplasty; Roux-en-y gastric bypass [ 51 , 52 ].

The effects of surgery on reflux symptoms are twofold in that these procedures reduce the BMI of patients and also physically alter the anatomy of the gastrointestinal tract.

The outcomes of such procedures have been the focus of many studies [ 53 — 55 ]. The Roux-en-y gastric bypass RYGB has demonstrated consistently favourable results as an antireflux procedure in several studies [ 56 — 59 ]. On balance, these studies provide strong evidence favouring RYGB surgery as a therapy for patients with morbid obesity suffering from concomitant GERD.

In conclusion, we have demonstrated that BMI does not influence the clinical short-term outcomes following LNF, but long-term control of reflux by LNF in obese patients is worse than that in normal weight subjects. Therefore obesity is a relative contraindication to LNF. The authors declare that there are no conflicts of interest regarding the publication of this paper.

This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors.

Read the winning articles. Journal overview. Special Issues. Academic Editor: Till Hasenberg. Received 12 Jan Revised 10 Apr Accepted 23 Apr Published 11 May Abstract Background. Methods and Materials This study was a retrospective analysis of prospectively collected data. Figure 1. Table 1. NERD nonerosive reflux disease. ERD erosive reflux disease. Table 2. Table 3. Table 4. Table 5. Reflux recurrence and esophageal hour pH-impedance monitoring. References R.

Hunt, G. Tytgat, P. Malfertheiner et al. View at: Google Scholar K. Fock, N. Talley, R. Hunt et al. Hampel, N. Abraham, and H. Kamolz, F. Granderath, T. Bammer, H. Wykypiel Jr. Broeders, H. Rijnhart-de Jong, W. Draaisma, A. Bredenoord, A. Smout, and H. View at: Google Scholar M. Schietroma, F. De Vita, F. Carlei et al. Perez, A. Moncure, and D. Morgenthal, E. Lin, M. Shane, J. Hunter, and C. D'Alessio, D. Arnaoutakis, N. Giarelli, D. Villadolid, and A.

Winslow, M. Frisella, N. Soper, and M. Fraser, D. Watson, C. O'Boyle, and G. Hahnloser, M. Schumacher, R. Cavin, B. Cosendey, and P. Campos, J. Peters, T. DeMeester et al. Anvari and F. Ng, M. Booth, J. Stratford, L. Jones, J. Sohanpal, and T.

Chisholm, G. Jamieson, C. Lally, P. Devitt, P. Game, and D. Tekin, T. Toydemir, and M. Telem, M. Altieri, G. Gracia, and A. Savary and G. Ghosh, J. Pandolfino, J. Rice, J. Clarke, M. Kwiatek, and P. G—G,