please click on the  thumbnail to the right for a detailed
  diagram of the procedure


DESCRIPTION
LAPAROSCOPIC NISSEN FUNDOPLICATION, HIATUS HERNIA REPAIR
The procedure involves the creation of a new lower oesophageal sphincter valve to cure gastro-oesophageal reflux disease (GORD or GERD), and the repair of a symptomatic hiatus hernia (if present) by laparoscopic surgery.


click here for a detailed diagram of the abdomen

INDICATIONS
1. Symptomatic hiatus hernia
2. Severe gastro-oesophageal reflux disease (GORD, GERD)
3. Surgery is usually indicated once a sufficient period of medical treatment, i.e. acid reducing medication, has been tried. Patients who respond to drug treatment but who are dependant on medication for relief of symptoms, should benefit from surgery

HOW TO MAKE THE DIAGNOSIS

1. Symptoms may include:
i. Heartburn
ii. Reflux/regurgitaion of food, acid, or bile
iii. Excessive burping/belching
iv. Nausea, vomiting
v. Pain, either upper abdominal, or central chest pain
vi. Asthma
vii. Voice changes, e.g. hoarseness

2. Investigations may include:
i. Gastroscope
ii. Barium swallow X-ray
iii. Oesophageal motility study
iv. Oesophageal acid monitoring (24 hr pH measurement)

BENEFITS OF SURGERY
Surgery should cure the symptoms of heartburn, reflux and hiatus hernia, and prevent possible complications of reflux disease, and hiatus hernia

HOW WILL MY BODY FUNCTION AFTER THIS PROCEDURE?
Early in the post-operative period some difficulty in swallowing solid or chunky food may be encountered. Patients are, therefore, advised to stay on fluids or a sloppy diet for the first 2-4 weeks, and then slowly increase their volume of food and build up to more solid food.

Meals will need to be smaller, initially, as patients will usually feel full sooner. This may result in loss of between 5 and 10 kg of weight in the early postoperative period (1 to 3 months). The volume of food will usually increase over a period of 6 - 12 months to what it was before (or close to this), and the patient's weight will often pick up accordingly to what it was before.
Some patients feel bloated after meals, and this should also improve with time.
Increased flatulence may be encountered.
More than 95% of patients should be satisfied after their operation.

DETAILS:
Anaesthetic: General Anaesthetic
Operation time: 30 - 90 minutes
Hospital stay: 1 - 3 days

Potential complications

1. difficulty swallowing
Some patients feel food getting stuck as it goes down past the new valve. This should be temporary and will improve with time until swallowing is back to normal.
2. "gas bloat"
T this is the feeling of gas trapped in the upper abdomen after a meal.Usually occurs only with overeating or eating too fast early on after the operation. This symptom should improve with time.
3. flatulence
See general complications of laparoscopic surgery

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