How Long Does a Nissen Fundoplication Surgery Take?

The surgery may take around three hours, after which a patient may take a few more hours to recover from anesthesia.

A Nissen fundoplication is a surgical procedure that treats gastroesophageal reflux disease (GERD), commonly known as acid reflux disease or hiatus hernia. The surgery is named after the surgeon who first performed it, Dr. Rudolph Nissen. It may be performed as an open surgery or minimally invasive laparoscopic surgery, which would be decided by the surgeon based on his/her experience and extent of disease. 

Gastroesophageal reflux disease (GERD): The lower esophageal sphincter is a circular band of muscle around the lower part of the esophagus at the junction of the stomach. It relaxes to allow food and liquids to pass into the stomach, after which it contracts to prevent backflow. 

If the sphincter dysfunctions cause weakening or abnormal relaxation, it causes the backflow of stomach acid into the esophagus. This is called GERD. Surgery for GERD is required only if there is no improvement despite medical treatment, lifestyle, and diet modification. 

Hiatus hernia: Hiatus hernia occurs when the upper part of your stomach bulges through the diaphragm (a large, thin sheet of muscle separating the abdomen and chest). The diaphragm has a small opening (hiatus) through which the esophagus (food pipe) passes and opens into the stomach. In hiatus hernia, the stomach rolls through the opening and into the chest.

A small hernia is usually asymptomatic. But a large hernia tends to allow food and acid to back up into the esophagus, leading to acid reflux. Many of the times, these symptoms can be managed conservatively with medication, diet, and lifestyle modifications. But a very large hernia would

Surgery is required if conservative management fails and the patient has no symptomatic relief. This is because the constant backwash of acid irritates the lining of your esophagus, leading to inflammation, scarring, or even malignancy.

The clinical features of a hiatus hernia are very similar to that of GERD. The common signs and symptoms are:

• Heartburn
• Regurgitation (backflow) of food or liquids into the mouth
• Acid reflux (backflow of stomach acid into the esophagus) 
• Halitosis (bad breath)
• Dysphagia (difficulty swallowing)
• Chest or abdominal pain or discomfort 
• Difficulty breathing
• Internal gastric bleeding, leading to vomiting of blood or passing of black stools

The patient first undergoes pre-operative assessment, and laboratory and radiological tests advised by the surgeon. The surgery is performed under anesthesia, either as an open surgery or minimally invasive laparoscopic surgery. 

During the surgery, the upper part of the stomach called the gastric fundus is wrapped around (plication) the entire lower end of the esophagus (360 degrees) and sutured (stitched). 

The hiatus through which the hernia occurs is also narrowed by suturing to prevent or treat the hernia. Hence, when the stomach contracts, it also closes the esophagus, preventing the reflux of stomach acids and food contents back into the esophagus. The surgery may take around three hours, after which a patient may take a few more hours to recover from anesthesia. 

The patient is usually discharged two to three days after surgery.

• In the hospital, painkillers, antibiotics, and antacids are administered. Nutritional therapy would be provided through a feeding tube or intravenously. 
• Patients may experience pain, swelling, and bruising, which usually resolves. 
• The esophagus and stomach would take two to three weeks to heal, during which patients would have to follow a soft solid or liquid diet suggested by the surgeon. 
• Patients may be prescribed antacids and nutritional supplements to continue after surgery for a few weeks. 
• Vigorous exercises, sports, and lifting heavy objects should be avoided for about six weeks after surgery.

The surgery is relatively safe with morbidity of less than 1%. Like any major surgery, fundoplication also has a risk for complications that are usually treatable or transient. Some common complications are:

• Bleeding 
• Infection
• Nausea and vomiting
• Hematoma (blood clot)
• Dysphagia (difficulty swallowing)
• Bloating
• Dumping syndrome (when food moves too quickly from the stomach to the intestine)
• Scarring 
• Damage to surrounding nerves like vagus nerve 
• Scarring 
• Transient irritable bowel syndrome 
• Recurrence of hiatus hernia or GERD