Open Nissen Fundoplication (GERD Surgery)

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (oesophagus).

1. This backwash (acid reflux) can irritate the lining of your oesophagus. Many people experience acid reflux from time to time
2. GERD is a common condition that causes burning sensations between the ribs and neck.
3. Other symptoms of GERD are vomiting, chest pain, a feeling of a lump in the throat, and difficulty in swallowing and coughing.
4. GERD surgery is a procedure that involves narrowing or closing off the oesophagus that prevents acid reflux from the stomach to the oesophagus.

1. Most people notice an improvement in acid reflux symptoms after a Nissen fundoplication.
2. Relieving GERD keeps you more comfortable
3. It reduces the chance of developing Barrett's oesophagus.
4. Barrett's oesophagus raises the risk of oesophagal cancer.

Why is this procedure done?

1. The sphincter muscles of the oesophagus relax at the wrong time. The situation allows the acid to travel back to the oesophagus.
2. The whole condition results in heartburn and is responsible for other symptoms, such as chest pain, feeling of a lump in the throat, and difficulty swallowing;
3. GERD surgery is crucial to treat heartburn. Heartburn is a condition that is not treated by other medications.
4. Even some lifestyle changes cannot cure heartburn. GERD surgery is also required for the severe inflammation of the oesophagus.
5. Hiatal Hernia also causes GERD.

What will happen if surgery is delayed? 

1.  If GERD is left untreated or delaying treatment, there is an increase in acid reflux.
2. In addition, it causes damage to the tissue lining of the oesophagus.  Delayed treatment can cause inflammation and pain.
3. Delayed treatment may even cause permanent damage to the oesophagus and may also result in an increased risk for oesophageal cancer.

There are various surgical procedures for managing GERD. These are:

Fundoplication: This technique works on the lower oesophagal sphincter and tightens and reinforces it. The upper part of the stomach is tightened around the lower oesophagus from outside. This surgery can be performed both as laparoscopic and open surgery. The surgery has good outcomes in the long term.

Transoral Incisionless Fundoplication: This surgery is performed when both the laparoscopic and open fundoplication is not possible. The surgery does not need any incision and creates a barrier between the stomach and oesophagus. As a result, it prevents the reflux of acid. The doctor inserts a device, EsophyX, in your mouth in this method. This device forms a valve at the base of the oesophagus by creating multiple folds.  

Bard EndoCinch System: This is an LES strengthening procedure. The doctor forms multiple pleats in LES by making the stitches. This technique uses an endoscope. Although this technique is not common, it may be required in some patients. Consult with your doctor if you are suitable for this method. 

Stretta Procedure: Stretta Procedure also uses an endoscope. The surgeon inserts the endoscope into the oesophagus. The tube has electrodes at the end. With the help of electrodes, the surgeon makes small cuts in the oesophagus. There is a formation of scar tissues due to these cuts. Scar tissue helps in strengthening surrounding muscles. The nerve that responds to the acid is also blocked. It is a new method, and long-term outcomes are not documented. 

Linx Surgery: The surgeon uses the special device, Linx, to perform surgery. It is a ring comprising magnetic titanium beads. The surgeon wraps it around the LES, resulting in strengthening the sphincter. The beads are away from each other due to the magnetic effect and provide an easy passage to the food. It is a minimally invasive surgery. 

What to expect before surgery? 

1. Every surgical procedure requires some medical tests before the surgery. These imaging tests are crucial to examine the exact situation of the stomach and the oesophagus.
2. GI X-rays: X-ray is conducted to take images of the stomach, oesophagus and small intestine.
3. Oesophagal manometry: It measures the pressure carried by the oesophagus while swallowing.
4. Upper endoscopy: The endoscopy examines the upper part of the stomach.

Before the surgery

1. The surgeon administers anaesthesia to the patient. Anaesthesia helps in preventing the brain from processing the pain. 
2. Administering anaesthesia also depends on the type of the procedure, such as endoscopy or GERD with an abdominal cut.
3. The surgeon will recommend not eating or drinking before the night of the surgery. 
4. The patient should avoid spicy and acidic food that can increase the acid in his stomach.
5. Stopping alcohol consumption and smoking a few days before the procedure is beneficial.
6. Some medications are also advised to be avoided before the surgery. 
7. Blood thinners and anti-inflammatory drugs should be avoided during the procedure. 
8. You should adjust the dose of the diabetic medications or steroids. 

 

What to expect on the day of surgery?

1. On the day of the surgery, a patient needs to register himself in the hospital. 
2. Hospital also asks to sign a consent form before the surgery. 
3. The healthcare provider asks you to give some blood samples for a test that includes CBC (complete blood count ) and a chemistry panel, including blood glucose levels, electrolyte levels, and kidney and liver function tests.
4. If these test reports do not show any acute problem like anaemia, the patient can undergo surgery. But the surgical team will have to prepare with blood transfusion procedure. 
5. Before the surgery, the patient will be instructed to wear a hospital gown. 
6. The healthcare team will place an IV in your hand or arm. They will check your body temperature, blood pressure, pulse and oxygen level.
7. What to expect during surgery?
8. The surgeon initially approaches the lower esophageal sphincter (LES). It is a ring-like structure present at the junction of the oesophagus and stomach. 
9. The surgical procedure depends on the type of surgery. Whether the surgeon approaches open or laparoscopic surgery.
10. Both types of procedures involve the administration of anaesthesia via IV. The patient is advised to have 30-degree prone to the supine or upright position on the operation table. 
11. The healthcare team will check the vitals of the patient throughout the procedure.
12. To start the final procedure, the surgeon needs to access the LES. 
13. Placing sutures near the LES is the next step to do. Finally, the laser is applied to make the LES narrow. 
14. Pulling up the top section of the stomach to LES that makes the opening tighten is the final step in the procedure. 
15. After finishing the procedure, your abdomen will be cleaned and covered with a surgical drape.

First follow-up appointment 

1. Your doctor will advise you to visit the hospital for follow-up and provide you with a date.
2. Always visit the hospital on scheduled follow-up consultation.
3. Doctors usually visit the hospital for follow-up within two to four weeks after the surgery.
4. The doctor will examine overall health depending upon the type of GERD surgery.
5. You may also ask questions about your symptoms, recovery time and resuming normal activities.