Nissen fundoplication

Jump to: navigation, search


Overview

WikiDoc Resources for Nissen fundoplication

Articles

Most recent articles on Nissen fundoplication

Most cited articles on Nissen fundoplication

Review articles on Nissen fundoplication

Articles on Nissen fundoplication in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Nissen fundoplication

Images of Nissen fundoplication

Photos of Nissen fundoplication

Podcasts & MP3s on Nissen fundoplication

Videos on Nissen fundoplication

Evidence Based Medicine

Cochrane Collaboration on Nissen fundoplication

Bandolier on Nissen fundoplication

TRIP on Nissen fundoplication

Clinical Trials

Ongoing Trials on Nissen fundoplication at Clinical Trials.gov

Trial results on Nissen fundoplication

Clinical Trials on Nissen fundoplication at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Nissen fundoplication

NICE Guidance on Nissen fundoplication

NHS PRODIGY Guidance

FDA on Nissen fundoplication

CDC on Nissen fundoplication

Books

Books on Nissen fundoplication

News

Nissen fundoplication in the news

Be alerted to news on Nissen fundoplication

News trends on Nissen fundoplication

Commentary

Blogs on Nissen fundoplication

Definitions

Definitions of Nissen fundoplication

Patient Resources / Community

Patient resources on Nissen fundoplication

Discussion groups on Nissen fundoplication

Patient Handouts on Nissen fundoplication

Directions to Hospitals Treating Nissen fundoplication

Risk calculators and risk factors for Nissen fundoplication

Healthcare Provider Resources

Symptoms of Nissen fundoplication

Causes & Risk Factors for Nissen fundoplication

Diagnostic studies for Nissen fundoplication

Treatment of Nissen fundoplication

Continuing Medical Education (CME)

CME Programs on Nissen fundoplication

International

Nissen fundoplication en Espanol

Nissen fundoplication en Francais

Business

Nissen fundoplication in the Marketplace

Patents on Nissen fundoplication

Experimental / Informatics

List of terms related to Nissen fundoplication

Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatus hernia. In GERD it is usually performed when medical therapy has failed, but with paraesophageal hiatus hernia, it is the first-line procedure. Partial fundoplications known as a Dor fundoplication or Toupet fundoplication may accompany surgery for achalasia.

The procedure

Diagram of a Nissen fundoplication.

In a fundoplication, the gastric fundus (upper part) of the stomach is wrapped, or plicated, around the inferior part of the esophagus, restoring the function of the lower esophageal sphincter. This prevents the reflux of gastric acid (in GERD) and/or the sliding of the fundus through the enlarged esophageal hiatus in the diaphragm. In a Nissen fundoplication, also called a complete fundoplication, the fundus is wrapped all the way around the esophagus.

Surgery for achalasia is generally accompanied by either a Dor or Toupet partial fundoplication. In a Dor (anterior) fundoplication, the fundus is laid over the top of the esophagus. In a Toupet (posterior) fundoplication, the fundus is wrapped around the back of the esophagus.

The procedure is often done laparoscopically. When used as a method to alleviate gastroesophageal reflux symptoms in patients with delayed gastric empyting, this procedure is frequently done in conjunction with modification of the pylorus via pyloromyotomy or pyloroplasty.

Nissen fundoplication is generally considered to be safe and effective, with a mortality rate of less than 1%. Studies have shown that after 10 years, 89.5% of patients are still symptom-free.[1]

Complications

Complications include "gas bloat syndrome", dysphagia (trouble swallowing), dumping syndrome, excessive scarring, and rarely, achalasia.[2] The procedure can also become undone over time in about 5-10% of cases, leading to recurrence of the symptoms. If the symptoms warrant repeated surgery, the surgeon may use Marlex or another form of artificial mesh to strengthen the connection.[3]

In "gas bloat syndrome", patients report being unable to belch, leading to an accumulation of gas in the stomach or small intestine. This is said to occur in 2-5% of patients, depending on surgical technique, and is commonly believed to be related to the tightness of the "wrap". Most often, gas bloat syndrome is self-limiting within 2 to 4 weeks, but in some it may persist. The offending gas may come from dietary sources (especially carbonated beverages). Another suspected cause is subconscious swallowing of air (aerophagia). If gas bloat syndrome occurs post operatively and does not resolve with time, dietary restrictions, or counselling regarding aerophagia, it may be beneficial to consider treating the condition with an endoscopic balloon dilitation.

History

Dr. Rudolph Nissen first performed the procedure in 1955, and published the results of two cases in a 1956 Swiss Medical Weekly.[4] In 1961 he published a more detailed overview of the procedure.[5] Nissen originally called the surgery gastroplication, but the procedure has borne his name since it gained popularity in the 1970's.[6]

References

  1. Minjarez, RC. "Surgical therapy for gastroesophageal reflux disease". GI Motility online. doi:10.1038/gimo56. 
  2. Waring JP (1999). "Postfundoplication complications. Prevention and management". Gastroenterol. Clin. North Am. 28 (4): 1007–19, viii–ix. PMID 10695014. 
  3. Curet MJ, Josloff RK, Schoeb O, Zucker KA (1999). "Laparoscopic reoperation for failed antireflux procedures". Archives of surgery. 134 (5): 559–63. PMID 10323431. 
  4. Nissen R (1956). "[A simple operation for control of reflux esophagitis.]". Schweizerische medizinische Wochenschrift (in German). 86 (Suppl 20): 590–2. PMID 13337262. 
  5. Nissen R (1961). "Gastropexy and "fundoplication" in surgical treatment of hiatal hernia". The American journal of digestive diseases. 6: 954–61. PMID 14480031. 
  6. Stylopoulos N, Rattner DW (2005). "The history of hiatal hernia surgery: from Bowditch to laparoscopy". Ann. Surg. 241 (1): 185–93. PMID 15622007. 

External links



Linked-in.jpg