Nissen fundoplication is a surgical procedure aimed at treating gastroesophageal reflux disease (GERD). Its primary goal is to enhance the function of the lower esophageal sphincter (LES) to prevent gastric acid from refluxing into the esophagus. The surgery involves wrapping the upper part of the stomach around the lower esophagus to create a physical valve mechanism, thereby improving complications such as chronic reflux, esophageal ulcers, and Barrett's esophagus. It is typically indicated for patients who do not respond to medication or have recurrent symptoms.
The procedure can be performed via traditional open surgery or laparoscopically. The minimally invasive laparoscopic approach, with smaller incisions and faster recovery, has become the mainstream choice. This treatment not only alleviates symptoms but also reduces dependence on long-term proton pump inhibitors (PPIs), making it an important option for GERD management.
This surgery is a form of anti-reflux procedure, specifically creating a 270-degree (three-and-a-half turns) wrap of the gastric fundus around the lower esophagus to form a "valve" structure. When the esophagus contracts, this structure automatically closes, blocking the reflux of gastric acid. The mechanism mimics the physiological function of the LES and reduces reflux triggers caused by abnormal esophageal dilation.
The operation is performed under general anesthesia. The laparoscopic version requires 3-5 small incisions of 0.5-1 cm in the abdomen for inserting a camera and surgical instruments. Postoperative hospitalization typically lasts 2-5 days, with recovery taking approximately 2-4 weeks. Multiple studies have confirmed that this anti-reflux effect can be maintained for 5-10 years.
Main indications include:
Additional indications include:
This is a one-time surgical procedure, requiring no repeated dosing or dosage adjustments. The surgical steps include:
The operation lasts about 2-4 hours and is performed under general anesthesia. Preoperative assessments include gastroscopy, 24-hour esophageal pH monitoring, and upper gastrointestinal imaging. Postoperative care involves dietary adjustments, with most patients resuming normal activities within 2-3 weeks.
Main advantages include:
Compared to traditional open surgery, laparoscopic Nissen fundoplication offers:
Potential risks include:
Serious complications include:
Preoperative preparations include:
Contraindications include:
Preoperative adjustments include:
Postoperative considerations include:
Multicenter studies show:
Follow-up studies confirm:
Non-surgical options include:
Other surgical options include:
However, these alternatives still lack the extensive long-term clinical evidence that supports the efficacy of Nissen surgery.
Postoperative dietary recovery should be phased. In the first week, only clear liquids such as rice porridge or broth are permitted. In the second week, gradually introduce low-fiber semi-liquid foods (such as congee or fruit purees), avoiding hot or cold beverages. From the third week onward, transition to soft foods, strictly avoiding spicy, greasy, or hard-to-chew foods. Small bites and slow eating are essential to prevent reflux.
Is difficulty swallowing within the first few weeks after surgery normal? When should I seek medical attention?Minor swallowing difficulties within 2-4 weeks post-surgery are common, mainly due to tissue swelling or muscular adaptation. If swallowing problems persist beyond six weeks, or if there is complete inability to eat solid foods or severe pain, immediate medical evaluation is necessary to assess for strictures or other complications. Endoscopic dilation or other treatments may be recommended by the physician.
When can I resume vigorous exercise or lifting heavy objects after surgery?It is generally advised to wait at least 6 weeks before engaging in strenuous activities or lifting objects over 5 kg to avoid stressing the sutures or abdominal muscles. The exact timing depends on individual recovery, and the doctor will adjust recommendations based on wound healing. Light activities such as walking can typically resume within 1-2 weeks.
Do I need to take acid suppressants long-term after surgery?Most patients can gradually reduce or discontinue acid suppressants within 3-6 months post-surgery, depending on preoperative gastric acid secretion and postoperative follow-up results. If there was severe esophageal ulceration or recurrent reflux before surgery, short-term medication use may be advised. Long-term follow-up is necessary, and if reflux symptoms recur, treatment strategies should be reevaluated.
What is the risk of esophageal stricture after surgery? How can it be prevented?The risk of esophageal stricture occurs in about 5-10% of patients within 1-3 years postoperatively, mainly due to fibrous tissue contraction at the sutured site. Prevention includes strict adherence to postoperative dietary guidelines, avoiding early solid food intake, and regular endoscopic follow-up. If stricture causes swallowing difficulty, balloon dilation under endoscopy can effectively relieve symptoms without the need for additional surgery.
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