This allows the esophagus to heal. If a person has a hiatal hernia , which can cause gastroesophageal reflux disease GERD symptoms, it will also be repaired during this surgery. If open surgery which requires a large incision is done, you will most likely spend several days in the hospital. A general anesthetic is used, which means you sleep through the operation. After open surgery, you may need 4 to 6 weeks to get back to work or your normal routine.
If the laparoscopic method is used, you will most likely be in the hospital for only 2 to 3 days. A general anesthetic is used. You will have less pain after surgery, because there is no large incision to heal.
After laparoscopic surgery, most people can go back to work or their normal routine in about 2 to 3 weeks, depending on their work. After either surgery, you may need to change the way you eat. You may need to eat only soft foods until the surgery heals. And you should chew food thoroughly and eat more slowly to give the food time to go down the esophagus.
Fundoplication surgery is most often used to treat GERD symptoms that are likely to be caused in part by a hiatal hernia and that have not been well controlled by medicines. The surgery may also be used for some people who do not have a hiatal hernia.
Surgery also may be an option when:. For some people, the side effects of surgery—bloating caused by gas buildup, swallowing problems, pain at the surgical site—are as bothersome as GERD symptoms. The fundoplication procedure cannot be reversed, and in some cases it may not be possible to relieve the symptoms of these complications, even with a second surgery. GERD can be annoying and even painful.
But it is not a dangerous disease. For any GERD treatment to be worth trying, it needs to be very safe. For many people, especially those who have few problems taking medicine, surgery is not a good choice. But when fundoplication surgery is successful, it may end the need for long-term treatment with medicine. When you are deciding between surgery and treatment with medicine, weigh the cost, risks, and potential complications of the surgery against the cost and inconvenience of taking medicine.
Avoid crusty breads, bagels, tough meats, raw vegetables, nuts and seeds including crackers and breads that have nuts and seeds , and other foods that are hard to digest. If you feel full quickly, try to drink fluids between meals instead of with meals. Avoid fizzy drinks, such as soda pop. Avoid drinking with straws. This may help you swallow less air when you drink. Gradually return to your normal foods. This usually takes 4 to 6 weeks. You may notice that your bowel movements are not regular right after your surgery.
This is common. Try to avoid constipation and straining with bowel movements. Take a fibre supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative. Your doctor will tell you if and when you can restart your medicines.
He or she will also give you instructions about taking any new medicines. If you take aspirin or some other blood thinner, ask your doctor if and when to start taking it again. Make sure that you understand exactly what your doctor wants you to do. Take pain medicines exactly as directed.
If the doctor gave you a prescription medicine for pain, take it as prescribed. If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine. If you think your pain medicine is making you sick to your stomach: Take your medicine after meals unless your doctor tells you not to.
Ask your doctor for a different pain medicine. If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics. Continue to take your acid-reducing medicine for 1 month after surgery or as your doctor tells you. If you have strips of tape on the cuts the doctor made incisions , leave the tape on for a week or until it falls off.
Wash the area daily with warm, soapy water and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day. Keep the area clean and dry. For example, call if: You passed out lost consciousness.
You are short of breath. Call your doctor or nurse call line now or seek immediate medical care if: You are sick to your stomach and cannot keep fluids down. You have pain that does not get better after you take pain medicine. You have signs of infection, such as: Increased pain, swelling, warmth, or redness. Red streaks leading from the incision. Thirteen of these procedures were for the repair of a paraesophageal hiatus hernia, 10 7 were for dysphagia 5 because of a tight esophageal hiatus, 11 and 2 for conversion of the Nissen fundoplication to a posterior partial fundoplication procedure , 3 were for recurrent reflux wrap undone , 3 were because of a technical error resulting in gastric obstruction creation of an exaggerated bilobed stomach 13 , and 1 patient underwent multiple laparotomies because of mesenteric thrombosis.
Another patient not included in the total underwent an esophagectomy following the development of severe dysplasia in a segment of Barrett esophagus. Eight patients were successfully managed with a single dilatation procedure, and 1 patient underwent several dilatations before adequate swallowing was achieved.
None of these patients had preoperative endoscopic evidence of an esophageal stricture, although 2 patients did experience preoperative dysphagia of similar severity to what they experienced postoperatively. Most patients reported a heartburn score of 7 or higher before surgery. Figure 1 and Figure 2 summarize the dysphagia scores for liquids and solids, respectively.
The overall number of patients with dysphagia with liquids was similar before and after surgery. Overall patient satisfaction with the procedure produced a mean satisfaction score of 8.
Laparoscopic antireflux surgery is a relatively recent innovation, with most published series describing short-term follow-up, 17 - 19 and relatively few series reporting medium-term outcomes with follow-up for 2 to 3 years after surgery. However, the long-term outcome of this operation will ultimately determine its place in the treatment armamentarium for gastroesophageal reflux, and it is essential to demonstrate an acceptable long-term outcome rather than simply to assume that because short-term results are acceptable, long-term results will be equally good.
This is of particular relevance to laparoscopic antireflux surgery because the introduction of this new technique was associated with unexpected complications, such as an increased incidence of paraesophageal hiatus herniation. Hence, we cannot be certain that long-term results can be extrapolated from short- to medium-term follow-up. The long-term outcome for open Nissen fundoplication has been reported previously. Long-term data is provided by various Scandinavian series. To achieve a minimum of 5 years' follow-up for laparoscopic Nissen fundoplication, we attempted interviews with every patient who underwent this procedure between September and July , generating a series of laparoscopic Nissen fundoplications.
We previously reported that there is a learning curve for this operation; the results of a surgeon inexperienced with this procedure are associated with a poorer outcome, a higher conversion rate, and a higher reoperation rate. Selectively omitting this group, who tended to be less satisfied with the outcome of their original procedure, could artificially enhance the quality of the overall outcome, and this should be avoided. Reoperation for paraesophageal hiatus herniation was common initially, and we have discussed this in detail elsewhere.
Since routinely narrowing the hiatus, the problem of postoperative herniation is now much less common. Similarly, the issue of a tight hiatus caused by fibrosis has become infrequent as we have made adjustments to our surgical technique. Postoperative dysphagia is often difficult to assess because the outcome reported depends on who asks about it eg, surgeon vs independent investigator , how the questions are constructed, and the scoring system used.
For this reason, it is better to consider data that compare the same patients at different time intervals as we have done here or comparative data from randomized trials. Within the current study, it is clear from Figure 1 that the incidence and severity of dysphagia with liquids was not influenced by laparoscopic Nissen fundoplication and that the number of patients with severe dysphagia with liquids at 5 years was less than the number reporting this problem before surgery.
For dysphagia with solid food, there were also less patients with severe dysphagia 5 years after surgery than before surgery. However, more patients reported minor dysphagia with solids at 5 years follow-up than before surgery, and this was caused by an increase in the number of patients with mild dysphagia with solids. Although severe dysphagia was less common, there were more patients overall with dysphagia after surgery, even though it was not usually troublesome and did not require any dietary modification.
Of importance for the assessment of laparoscopic Nissen fundoplication is its ability to abolish reflux symptoms, particularly heartburn. The outcomes are similar to those following open Nissen fundoplication, suggesting that the laparoscopic approach does not compromise reflux control. However, our follow-up is clinical only, and objective follow-up using either pH or endoscopic studies was not sought. It is certainly possible that a few patients who claimed relief of reflux symptoms might demonstrate abnormalities if they underwent either pH monitoring or endoscopy.
On the other hand, some of the patients who claimed to experience symptomatic reflux following surgery had no objective evidence of reflux when they underwent postoperative testing. For this reason, in a clinical practice setting, the symptoms experienced by patients ultimately determine the success or failure of the operations we perform, not the outcome of follow-up tests or the surgeon's opinion about technical success.
Hence, we believe that laparoscopic Nissen fundoplication is an effective long-term treatment for gastroesophageal reflux disease, yielding similar results to open fundoplication but with the short-term advantages of quicker recovery and reduced wound-related morbidity. Corresponding author: David I. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue.
Figure 1. View Large Download. Am J Surg.
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