Laparoscopic Nissen Fundoplication

 

Operation

A laparoscopic partial (Dor or Toupet) or full (Nissen) fundoplication is a minimally invasive approach that involves specialized video equipment and instruments that allow a surgeon to place a wrap around the esophagus through several tiny incisions, most of which are less than a half-centimeter in size. The concept of the repair remains the same as the open approach. The part of the stomach is wrapped partially or completely around the esophagus in order to prevent further reflux symptoms.  The advantages of this method include a shorter hospitalization, less pain, fewer and smaller scars, and a shorter recovery.  Recently, we have been using the robot to perform robot assisted esophageal surgery.  Robot is a technology that enhances the surgeon’s ability to perform minimally invasive surgeries with improved visualization.

 

File:Nissen fundoplication.png

Risks

Robot assisted or laparoscopic fundoplication is a safe and effective treatment for GERD. However, in the presence of infection, adhesions, or variations in anatomy, this method becomes dangerous and your surgeon may need to make the prudent decision to continue by making the traditional incision to safely complete the operation. This should not be seen as a failure, but as a wise decision by your surgeon to prevent dangerous complications.  Other complications include gas bloat syndrome which is patient being unable to belch and leading to discomfort, trouble swallowing, unwrapping of the fundoplication. Other rare complications, include bleeding and infection. It is uncommon to require a blood transfusion for this operation. There is a slight risk of injury to the vagus nerve, esophagus, liver, stomach, bowel, lung, and spleen.  Post-operatively, rare problems may occur, these include difficulty with swallowing or the repaired area slipping back into the chest.

Recovery

After the operation, most patients take clear liquids next day and start on full liquid diet two days after the operation and return to normal diet in 2 weeks.  The typical hospital stay is 1 days, and many patients can return to work after two weeks. If the surgery is done open instead of laparoscopically, patients may need to take about 6 weeks off work. Heavy lifting is typically restricted for six weeks or more.

Long Term Outcome

Minimally invasive laparoscopic fundoplication is a long-term treatment for GERD.  Over 89% of the patients who undergo the operation still has resolution of symptoms in 10 years.