Nissen fundoplication

Hernia Repair

Colectomy

Cardiomyotomy
(Heller Myotomy)

Splenectomy

Cholecystectomy

Adrenalectomy

Gastric Bypass

Glossary

Members of
SAGES

The Society
of American
Gastrointestinal
Endoscopic
Surgeons

Laparoscopic
Nissen fundoplication

When GERD is too severe to be improved by altering diet, making lifestyle changes or administering medicine, your doctor may recommend surgery. The planned result of this surgery is a dramatic reduction or elimination of GERD causes and symptoms Research over the years indicates that the procedure is 95% successful.

Basically, the surgery, which requires general anesthesia, will reposition the lower esophageal sphincter (LES) muscle so it closes properly. This is carried out as part of what is called laparoscopic Nissen fundoplication surgery.

Instead of making a long incision used in traditional open surgery, Doctors Shikora and Tarnoff make five small incisions just large enough to allow a miniature high-definition camera and similarly small surgical instruments to be introduced with minimal trauma. The operating room in which the surgery is performed is distinguished by the number and type of large high-technology flat screen view screens and electronic equipment that make the miracle of minimally invasive laparoscopic surgery possible. While it continues to be a hands-on exercise in precision surgery, the doctor uses the camera as a “window” to view the area to be repaired, thus eliminating the need for a large incision.

Once the camera and instruments are inserted into the cavity, the surgeon can get to work on a procedure that takes two hours to complete. In a case where the stomach has protruded partially through the hiatus of the diaphragm into the chest cavity, the stomach is manipulated back into its proper place and the hiatus is tightened. Finallly, the stomach is wrapped around the lower esophagus to strengthen the LES.

Successful surgery improves the functioning of the sphincter muscle at the bottom of the esophagus, augments the barrier to reflux, and may speed the rate of gastric emptying. Because the surgery disturbs only a small fraction of the muscle layers and other tissues, patients stay in the hospital for just one or two days. By comparison, patients needing open surgery (Open Nissen fundoplication) can expect a longer hospital stay and may experience a longer recovery time. The rate of patient satisfaction is around 95%.

Gastroesophegeal
Reflux Disease (GERD)

Gastroesophegeal reflux disease (GERD) is diagnosed when a patient experiences a spectrum of symptoms caused by splashing (refluxing) gastric acid into the esophagus, damaging it. Symptoms can occur when the lower esophageal sphincter, a band of muscle fibers that usually closes off the esophagus from the stomach no longer closes properly after food passes through it. Moreover, the stomach can protrude partially through the opening (hiatus) of the diaphragm into the chest cavity (see picture).

This is called a hiatal hernia. Heartburn is one of GERD’s most common symptoms. Others include regurgitation of gastric acid or sour contents into the mouth, difficult or painful swallowing, and chest pain. GERD is also referred to by other names, including reflux, reflux esophagitis, or hiatus hernia.

According to the National Institutes of Health, about 7 million people suffer from GERD. Only patients who have cases so severe that they cannot be improved are referred to a surgeon.

Hiatal Hernia

The esophagus is attached to the top of the stomach, known as the fundus. There is an opening (hiatus) in the muscle of the diaphagm between the abdomen and chest through which passes the lower end of the esophagus (see below)

This diagram shows a Hiatal Hernia.

When the hiatus becomes too large, the valve that prevents the contents of the stomach from flowing back into the stomach doesn’t close properly. This can be an additional cause for GERD.

Paraesophageal Hernia

In more severe cases, the stomach can migrate into the lower chest (a paraesophageal hernia). In most cases, this results in symptoms ranging from mild heartburn to difficulty swallowing food, including frequent belching. Rarely, the stomach can become trapped in the chest leading to life threatening infection. This latter possibility, though remote, has lead most surgeons to recommend routine repair of any paraesophageal hernia, regardless of symptoms. Laparoscopic repair of these hernias yields significant benefit both in terms of ease with which the procedure is performed and in terms of a shorter , easier recovery.