The Nissen Fundoplication is the standard "anti-reflux" surgery. It is usually considered to be a last resort surgery. Under some conditions it is done on an emergency basis to stop life threatening events. Generally speaking the surgery is done after meeting some standard criteria. While the Fundoplication surgery is the standard surgery it is not a 'fix all.' We have compiled a list of pros and cons based on our observed experiences.

PROS:

The surgery is designed to improve the function of the stomach and esophagus. It works by creating an 'artificial' valve at the top of the stomach which when successful it prevents much the stomach contents from 'refluxing' back up into the esophagus. By doing so it can prevent erosion of the esophagus as well as life threatening events such as: aspiration, apnea and bradycardia.

The most important positive is that the pain from heartburn should subside.

After a successful Fundoplication the esophagus should begin to heal. This minimizes pain when swallowing. After fully healing in theory patients who had food aversions due to pain should start to 'rediscover' eating. While this isn't always the case it is the goal.

Many patients who spent much of their lives sleeping in inclined positions will find that now they can sleep on a flat bed. Thus, allowing them more comfort and flexibility in their sleep positions.

Patients who had reflux symptoms due to foods (i.e. spicy foods) now find flexibility in their diet. People who couldn't have chocolate or orange juice may now find that they tolerate a greater variety of foods than ever before.

The goal of the Nissen Fundoplication is to provide the patient with a 'normal' life. To eliminate the need for monitors, or the need to drag medicines everywhere you go. To allow the patient to eat med-free, to sleep med-free.... Unfortunately, this is not always achieved which leads us to the 'cons' section.

The Cons:

The cons of the surgery are what often makes the decision to proceed with surgery a hard one. The most common complication from the surgery is a continued need for anti-reflux medications. 62% of fundo patients will still require medications on a regular basis.

  You also have the possibility of Reflux recurring in about 10% of the cases. Failure of the operation may be more frequent in children with neurological problems or when done on young infants. The success rate improves with age.

 As many as 15% of children who have a fundoplication will develop an intestinal obstruction from scar formation or adhesions.

After a successful Nissen fundoplication, a child will not be able to burp or vomit. The inability to burp can cause a problem called gas-bloat 36% where the stomach fills with air that can't be easily expelled. For this reason, they place a gastrostomy at the time of the fundoplication in young children, even if they are able to eat by mouth. Since children are no longer able to vomit 31% after a Nissen fundoplication, they may have episodes of retching when they have a reason to vomit--such as the stomach flu. Some children may need to be brought to the emergency room for placement of a tube in the stomach through the mouth if there is no G-tube.

 A fundoplication can occasionally cause intermittent diarrhea or sweaty episodes (dumping syndrome) after a feed this is more common if a pyloriplasty is done along with the fundo. If the wrap is too tight, swallowing difficulties (dysphagia) 44% can occur. This causes eating problems and even retching or gagging 25% if food gets caught on the wrap. Dysphagia is more common in the laparoscopic procedure.