Do you also have a tendency to constantly feel a burning sensation in your chest and a sour taste in your throat? Does this condition worsen if the food you eat is a little spicy, or if you lie down for a while after eating at night? This is the main symptom of a condition that many people call "gastritis", but in medical terms we call it Gastroesophageal Reflux Disease, or GERD for short. Sometimes, even taking medication and making lifestyle changes does not reduce this annoying condition. At such times, today we are going to talk about a special surgery that doctors recommend.
First of all, what is GERD?
Simply put, GERD is a condition that occurs in our digestive system. There is a tube that carries the food we eat from our mouth to our stomach (stomach), and we call it the esophagus . Normally, there is a valve between the esophagus and the stomach to prevent the strong acids in the stomach, which help digest food, from flowing back up the esophagus.
But in GERD, this valve doesn't work properly, so stomach acid and digested food flow back up into the esophagus. It's okay if this happens once or twice, but when it happens continuously or chronically, we call it GERD. This acid is what causes you to feel things like a burning sensation in your chest and sore throat.
So what is this Nissen Fundoplication surgery?
Okay, now let's talk about this surgery. Nissen Fundoplication is a surgery that I mentioned earlier to correct the GERD condition. What this does is strengthen the part that acts like a valve where the esophagus and stomach meet.
How is it done? Imagine that our surgeon takes the top part of the stomach (we call it the fundus) and wraps it around the bottom part of the esophagus and tightens it. It's like we take a piece of cloth and wrap it around a tube and tie a knot. This tightens the loose valve-like part, preventing the stomach acid from coming back up. This is the main thing that happens with this surgery.
There are two ways to perform this surgery.
Doctors perform this surgery in two main ways. Your doctor will decide which method is best for you based on your condition.
| Surgical method | Description |
|---|---|
| Laparoscopic Procedure | This is the most commonly used, modern method. Here, a large incision is not made in the abdomen. Instead, the surgery is performed by making 4 or 5 very small incisions, inserting a camera (Laparoscope) through one of the incisions and very small surgical instruments through the other incisions. The images from the camera are viewed on a monitor, allowing the surgery to be performed very delicately. |
| Open Procedure | This is the traditional method. Here, a slightly larger incision is made in the abdomen, allowing the surgeon to see the organs directly. This method is usually used when there are other complications, or when the laparoscopic method is not possible. |
Who wants to have this surgery?
Not everyone with GERD will need this surgery.
Initially, your doctor will try to control the condition through medications and lifestyle changes (e.g., reducing spicy and oily foods, and taking a longer break from eating at night before going to bed).
However, if your symptoms do not improve despite these measures, or if you are not comfortable taking medication for a long time or are experiencing other side effects from the medication, your doctor may recommend Nissen Fundoplication. This surgery can be performed on both children and adults.
What do you do before surgery?
After deciding to have surgery, your doctor will order several tests to accurately assess the condition of your esophagus and stomach.
- GI X-rays (Barium Swallow): A special liquid called barium is swallowed and X-ray images are taken as it travels down the esophagus. This can help determine if there is any blockage in the esophagus.
- Esophageal Manometry: A small tube is inserted through your nose into your esophagus and measures the pressure in the muscles of your esophagus when you swallow something.
- Upper Endoscopy: The "endoscopy" test we all know. A tube with a camera attached is inserted through the mouth and examined the esophagus, stomach, and the first part of the small intestine.
- pH Probe: A test that measures how much acid is in the esophagus and how long it stays there.
These tests can sometimes detect a condition called a hiatal hernia . This is when the upper part of the stomach protrudes into the chest cavity. This can also increase GERD symptoms. This condition can also be corrected with surgery.
What happens after the surgery?
When you wake up after the surgery, you are in the ward.
- Your throat may hurt a little for the first couple of days.
- If you had open surgery, a tube (Nasogastric - NG tube) will be placed through your nose to drain any fluid that collects in your stomach. It will be removed after a while.
- Until you are able to eat and drink again, you will be given fluids through an IV line.
- When you pass gas or have a bowel movement, it means your digestive system is starting to function normally again. After that, you can gradually start eating.
Typically, if you have laparoscopic surgery, you can go home in a day or two. If you have open surgery, you will have to stay in the hospital for a few days.
What are the benefits and risks of this surgery?
Like any other option, this one has advantages and minor risks.
The main benefit is the significant relief from GERD symptoms. The constant heartburn and regurgitation are gone. It also helps reduce the risk of developing esophageal cancer (Barrett's esophagus) due to GERD in the long term. Especially if the surgery is done laparoscopically, there is less pain, faster recovery, and shorter hospital stays.
When it comes to risks , the main thing is that sometimes the relief from this surgery is not permanent. A very small number of people may need to have the surgery again in a few years. Also, as with any surgery, there is a small risk of infection in the incision.
How long does it take to heal?
After you go home, your doctor will likely recommend a liquid or soft foods diet for the first week or two. For example, soup, yogurt, porridge, and mashed potatoes. After that, you can gradually transition to regular foods.
You can resume normal activities within a few days after surgery. However, it is best to avoid heavy lifting or strenuous exercise for at least three weeks. Your doctor will give you specific instructions on this.
When do you want to see the doctor again?
If your symptoms return after surgery, be sure to see your doctor. It is also normal to have some swelling around the surgical wound. However, if you experience any of the following symptoms, call your doctor immediately.
- If the wound is bleeding
- If the swelling increases excessively
- If you get a fever
- If the skin around the wound is red and feels hot
- If vomiting occurs
Take-Home Message
- Nissen Fundoplication is a successful surgery for severe GERD (heartburn/reflux) that cannot be controlled with medication.
- This surgery stops stomach acid from coming back up into the esophagus.
- This surgery is often performed with the help of a camera (laparoscopic), so the pain is less and the recovery is quicker.
- After surgery, it is very important to follow the doctor's diet and instructions exactly for a speedy recovery.
- If signs or symptoms of wound infection recur, see your doctor without delay.
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