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VCU Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University VCU Division of Cardiothoracic Surgery VCU Medical Center VCU

VCU Division of Cardiothoracic Surgery

Laparoscopic Nissen Fundoplication

The goal of this minimally invasive operation is to restore normal anatomy and function of the esophagus, LES and stomach.  The highest portion of stomach is wrapped around in 360 degrees around the lower part of the esophagus in the abdomen to recreate the LES.  This wrap works as a valve which is loose enough to allow passage of food and at the same time just tight enough to prevent passage of food and acid back into the esophagus.

If there is a hiatal hernia present as well, the surgery involved reducing the displaced stomach back into the abdominal cavity and closure of the opening in the diaphragm to prevent it from going back up again.

Important surgical points
  • The nerves supplying the stomach and liver are preserved during the procedure.
  • The surgery is 1-2 hours long and is performed under a general anesthetic.
  • Patients are up and walking the same day
  • It is critical to gauge the tightness of the wrap during the operation so as to not make it too tight or too loose.
  • In patients with large hiatal hernia, shortened esophagus and with weak squeeze function of the esophagus (motility), a modification of Nissen may be required.  These include Toupet fundoplication (270 degree wrap), Dor fundoplication (180 degree wrap), Collis gastroplasty (esophageal lengthening procedure) and gastropexy.
Care after Nissen Fundoplication
  • Patients go home on a full liquid diet that can be advanced to a regular diet in a week
  • Patients are given pain medications after the surgery to take by mouth as needed
  • Constipation is to be avoided after the surgery
  • We advise patients not to engage in strenuous activity or heavy lifting (more than 10 lbs) for 4 weeks after surgery
  • Most patients are off pain medications after 7-10 days and can go back to work in 2-3 weeks
  • All patients after surgery receive a DIETERY CONSULTATION in the hospital to go over their food choices, recommended diet and answer your questions
  • Patients are advised not to drink carbonated beverages after the procedure
Side effects of Laparoscopic Nissen Fundoplication

Nissen fundoplication, done with care and with the wrap calibrated to be of optimal pressure will give patients excellent symptom relief over their lifetime.  Some patients may develop bloating and difficulty with vomit or belch of varying severity.


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