Nissen Fundoplication (Acid Reflux Surgery) - Gerd Surgery Kenya

GERD is characterized by acid moving from your stomach back to the esophagus and back. Typical symptoms encompass heartburn and regurgitation, while atypical symptoms may include chest pain, dysphagia, abdominal discomfort, nausea, and bloating. Extraesophageal symptoms can present such as cough, hoarseness, pulmonary complications, and laryngotracheal stenosis. Initially, medical management encompasses lifestyle changes and the use of medications, including proton pump inhibitors, H2 receptor antagonists, and sucralfate. The surgical approach can be employed by surgeons to address various digestive disorders, such as:

• Severe gastroesophageal reflux disease (GERD)
• hiatal hernia, a condition characterized by the stomach protruding through the diaphragm
• mild gastroparesis, a disorder where the stomach has a delayed emptying process.

What is Nissen Fundoplication?

A surgical procedure designed to address gastroesophageal reflux disease (GERD). This operation involves reinforcing the connection between the esophagus and the stomach to inhibit the occurrence of acid reflux. It can be laparoscopically (key hole surgery) or open surgery (with a cut in the abdomen)

Types of fundoplication

• Nissen fundoplication involves the surgeon encircling the upper portion of the stomach completely around the lower segment of the esophagus.
• Partial fundoplication entails the surgeon wrapping the stomach partially around the esophagus, which can be done either at the front (anterior fundoplication) or at the back (posterior or Toupet fundoplication).

Preparing for fundoplication

• Diagnostic tests to evaluate the condition of your stomach and esophagus before procedure- barium swallow X-rays, Esophageal manometry – pressure in esophagus , upper endoscopy, pH probe -acid in the esophagus.
• Fast before the procedure. You’ll typically need to stop eating solid food for 12 hrs and stop drinking liquids for 5 hrs before your procedure. This is to ensure your stomach is empty for the procedure.
• Stop taking certain anticoagulation medications.
• Tell your provider about any medications or allergies
• If you smoke or take alcohol, you may be asked to stop well before surgery.

Procedure

• Under general anesthesia, the laparoscope, which is a small instrument equipped with a camera, is inserted into the abdominal cavity through tiny incisions in your abdomen
• The images captured by the camera, along with miniature surgical instruments, are utilized to encircle the upper portion of the stomach around the lower esophagus.
• The fundus is then wrapped around the tissue of the lower esophagus.
• Dissolvable sutures are employed to secure the fundus to the esophagus.
• Any gas present in the abdominal area is expelled, and all surgical instruments are withdrawn from the site.
• Finally, the incisions are closed using dissolvable stitches.
The surgery typically requires between 2 to 4 hours, this approach results in a reduced recovery duration and produces smaller incisions compared to an open surgical method.

Recovery

The duration of your recovery following fundoplication may vary based on personal factors and the specific type of procedure performed. Anticipate the following during your recovery period:

• A hospital stay may be necessary for 1 or 2 days’ post-surgery: In cases of open surgery, an extended stay may be required.
• Upon returning home, you might still have surgical dressings or adhesive strips covering your incisions: These are intended to control bleeding and drainage. Your surgical team will inform you when it is appropriate to remove them.
• Your physician may suggest pain medications: These can help alleviate pain or discomfort after your discharge from the hospital. Should these medications prove ineffective, a stronger prescription may be provided.
• It is crucial to contact your doctor immediately if you notice increased redness, irritation, or pus discharge from the incisions within the first two weeks following surgery.
• If you have non-dissolvable stitches, a follow-up appointment may be necessary for their removal.
• Attend follow-up appointments to ensure that your incisions are healing properly and that you are not experiencing any complications.
• Experiencing illness, typically of brief duration.
• Encountering challenges with swallowing during the initial days or weeks.
• Experiencing bloating and discomfort following meals.

Dietary guidelines

Post-surgery, you will be on a clear liquid diet for a certain period. If you can tolerate the clear liquid diet, then the team may transition you to a full liquid diet. The duration of this phase can differ based on your surgeon's advice and your individual tolerance to food. You will be able to progressively resume to semi solids then to your normal solid diet in accordance with your team’s instructions.

Potential Complications:

Any surgical procedure carries the potential for complications. While these occurrences are infrequent, the following complications may arise from fundoplication:

• Perforation of the esophageal lining or walls, stomach, or surrounding lung tissues, spleen, liver (with a higher likelihood during laparoscopic surgeries).
• Infection in the wound, in the belly, or in the bloodstream
• Rupture of stitches, leading to exposure of the surgical site.
• Respiratory infections, such as pneumonia.
• Challenges with swallowing - dumping syndrome, characterized by rapid transit of food from the stomach to the intestines (although this is uncommon).
• Nausea and retching - accumulation of gas in the stomach - inability to vomit when necessary - persistent reflux despite the surgical intervention.
• Bleeding
• The alleviation of symptoms may rarely require an additional surgical procedure within a span of two to three years.

When is it necessary to consult my healthcare provider?

If symptoms of acid reflux reappear following surgery, it is advisable to contact your healthcare provider. Additionally, it is common to observe some swelling around the surgical incision post-operation. You should reach out to your healthcare provider if you encounter any of the following:

• Bleeding or pus coming from any of the small cuts in the surgery area – Or redness that spreads or gets worse.
• Significant swelling of the stomach.
• Fever that does not go down on its own or with non-prescription medicine.
• Redness or warmth of the skin surrounding the incision.
• Nausea and vomiting that does not resolve with medications.
• Pain does not get better when you take your pain medicines.
• Chills
• Persistent cough or breathing difficulties that do not improve.