Professor MD MD hc Guido Schumacher
Fundoplication is a surgical procedure for gastroestrofageal reflux disease (GERD). The word “fundoplication” origins from “fundus”, which is the name for the upper portion of the stomach, and “plication”, a process of gathering of the upper stomach curve and sewing it around esophageal sphincter. This kind of stomach wrap helps to prevent acid reflux into the food pipe which often happens when the valve in gastroesophageal junction does not close tightly enough.
Traditionally the procedure was done in open surgery but now, when minimally invasive methods have proved themselves in different fields of surgery, laparoscopic fundoplication is performed more often. In Clinic of Braunschweig we mostly use laparascopic Nissen fundoplication for GERD. It is called in honour of Rudolph Nissen who was a first surgeon applied gastroplication, as it was then called, and given its detailed report.
Laparoscopic Nissen fundoplication is normally used in cases when conservative treatment did not cure reflux disease. Continuous symptoms of heartburn can worsen patient’s life quality significantly while the surgery can solve this problem mechanically creating a barrier for stomach acid gushing out.
Nissen Fundoplication is complete fundopliction that means 360° wrap of the fundus around the lower end of the esophagus. There are also a few similar procedures that differ by degree of wrapping and have slightly different indications. For example, 270° Toupet fundoplication is more popular in pediatrics, whilst Nissen Fundoplication is common treatment for adults.
With standard laparoscopic surgery techniques for fundoplication a surgeon uses 5 incisions to introduce a camera and the tools via special devices (ports) named “trocars”. The camera, which is placed in the middle port, translates magnified images and the surgeon can control process of operation on the monitor.
Surgery is performed under general anesthesia. First, the liver is elevated with special atraumatic retractor. If a patient has hernia, it should be reduced before fundoplication. The stomach is mobilized and upper part if it is thoroughly wrapped around the esophagus. Then, the surgeon tightens it and sutured with 2-3 stitches. Whole process takes 1-1.5 hours.
Recovery for laparoscopic fundoplication is shorter than for traditional open surgery. You may expect to stay in hospital for 2-3 days and to return to normal life in 2 weeks.
You will be advised to keep a special diet for several weeks after laparoscopic Nissen fundoplication, avoiding hard food as you may experience some difficulties with swallowing that normally gone in 2-3 weeks.
Herniation of the wrap sutures is the most common (1.3%) complication of laparoscopic Nissen fundoplication. Among the other you could name:
There is some probability of failed surgery like too tight fundoplication, slipped fundoplication and malpositioning. In those cases, repeated surgery may be required. With laparoscopic Nissen fundoplication having the surgeon experienced at this type of surgery is a matter of high importance, as operating through “keyhole” requires high accuracy.
Some sources claim that laparoscopic Nissen fundoplication could lead to significant weight loss but there are no any researches an official statistics on this matter. Some people lose weight after surgery as they reduce the amount of food consumed and change its quality. But there is no any evidence that it is result of fundoplication rather than diet.
Clinic of Braunschweig with its numerous clinics and centers offers to patients with GARD a range of treatment options and laparoscopic Nissen fundolication is one of them. Clinic of General and Visceral Surgery headed by Prof. Dr. Dr. h. c. Guido Schumacher has a number of top stomach surgeons in its staff. In our clinic any kind of surgery is team work and you will be under care of the experienced surgeons, assistants, anesthetists and nurses during operation and after. With our comprehensive service you are guaranteed to be advised only proper treatment according to your health options.
We also meet your insurance requirement. You may have treatment both for hernia and laparoscopic Nissen fundoplication under cpt code 43280 listed for laparoscopic esophagogastric fundoplasty. If you have some doubts considering your treatment please contact us and our specialist will give you all the details on Nissen fundolication.