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The following images are of a Laparoscopic Nissen
Fundoplication. The anatomy effect of the surgery is the same whether it's
an "Open" or "Lap" Nissen. |
The Fundoplication is a surgery done to
control Gastroesophageal Reflux Disease (GERD). This condition if left
untreated can cause a variety of complications including esophageal cancer
and lung damage. Most reflux is controllable by the use of medications but
occasionally the medications don't work or just aren't enough. When this
is the case, the doctors have to turn to surgery. Here is a description of
what happens in the surgery. The "fundus" (hence the term fundoplication) of the stomach (top portion of the stomach) is wrapped around the back of the esophagus until it is once again in front. The portion of the fundus that is now on the right side of the esophagus is sutured to the portion on the left side to keep the wrap in place. When completed, the fundoplication resembles a buttoned shirt collar. The collar is the fundus wrap and the neck represents the esophagus inside the wrap. This has the effect of creating a one-way valve in the esophagus to allow food to pass into the stomach, but prevent stomach acid from flowing into the esophagus and thus prevent GERD. If the child also has a hiatal hernia this will be repaired at the same time.  The procedure is performed with the patient under general anesthesia in one of 2 ways ether 'open' or 'laproscopically'. The laparoscopic is the more popular way of doing it because it is less invasive. Five small incisions are made in the abdomen rather than one larger one used in the open. One is used for the laparoscope, the other four are used to retract and manipulate structures in the abdomen. Often a gastrostomy tube will be placed to help with the post op recovery. If one is placed it will usually only be in place for a few months unless needed for feeding or continuing gas bloat issues. There can also be another procedure done at the same time as the fundoplication for children with Delayed Gastric Emptying (DGE) this is called a pyloriplasty and it helps the stomach empty faster. If this is done your hospital stay will be a few days longer. In a small number of patients (approx. 5%) it may not be possible to operate via the laparoscope due to adhesions from previous operations, bleeding obscuring vision, awkward fatty tissue or other technical problems. It may then be necessary to revert to the standard (open) operation. Continued on the Next Page Back to the Main Page Please note: the information provided on this website is a combination of research and experience of parents. Please discuss any concerns with your doctor. The goal of this page is not to push or dissuade anyone in regard to the Fundo, but only to paint a broader picture. |
