Laparoscopic Nissen Fundoplication for Gastroesophageal Reflux Disease (GERD)
When stomach acid refluxes (or surges upward) from the stomach into the esophagus (food swallowing tube), patients experience symptoms such as indigestion, heartburn, chest pain or coughing and wheezing. Over time, patients may develop more severe symptoms, including ulcers or narrowing of the esophagus, which can cause swallowing difficulty.
Typically a sphincter, or valve-like muscle, located where the esophagus meets the stomach, opens during swallowing but closes tightly to prevent acid from surging into the esophagus. For some people, the valve relaxes at the wrong time, and for others it is not strong enough to close tightly and prevent reflux.
GERD is a common condition, normally manageable with antacid medication. However, for those patients who do not respond to medication, or who have very severe symptoms, laparoscopic surgery is a corrective option.
The most common anti-reflux operation, the Nissen fundoplication, is performed using standard open surgical technique. However, over the past several years, surgeons have been able to perform the Nissen fundoplication procedure using minimally invasive technique. Instead of one large incision, surgeons use five or six "keyhole" incisions, pencil width in size, which greatly improves recuperation time and patient comfort. In the procedure, the left side of the fundus, or upper part of the stomach, is freed from the surrounding tissue, wrapped around the lower part of the esophagus, and sewn to itself to buttress the sphincter valve. While complications can occur, most patients are free of reflux symptoms and the need to take any antacid medications.
