Nissen fundoplication is a surgical procedure aimed at treating gastroesophageal reflux disease (GERD). Its primary goal is to strengthen the function of the lower esophageal sphincter (LES) to prevent gastric acid reflux into the esophagus. The surgery involves wrapping the upper part of the stomach around the lower esophagus to create a physical valve mechanism, thereby improving complications such as chronic reflux, esophageal ulcers, and Barrett's esophagus. It is typically indicated for patients who do not respond to medication or experience recurrent symptoms.
The procedure can be performed via traditional open surgery or laparoscopically. The minimally invasive laparoscopic approach, due to its smaller incisions and faster recovery, has become the mainstream choice. This treatment not only alleviates symptoms but also reduces long-term dependence on proton pump inhibitors (PPIs), making it an important option for GERD management.
This surgery is a form of anti-reflux procedure, specifically involving a complete 270-degree (three-and-a-half turns) wrap of the gastric fundus around the lower esophagus, forming a "valve" structure. When the esophagus contracts, this structure automatically closes, blocking the reflux of gastric acid. The mechanism mimics the physiological function of the LES and reduces reflux triggers caused by abnormal esophageal dilation.
The operation is performed under general anesthesia. The laparoscopic version requires 3-5 small incisions of 0.5-1 cm in the abdomen, through which a camera and surgical instruments are inserted. Postoperative hospitalization typically lasts 2-5 days, with recovery taking approximately 2-4 weeks. The anti-reflux effect of this mechanism has been confirmed by multiple studies to last for more than 5-10 years.
Mainly suitable for:
Additional indications include:
This is a one-time surgical procedure, requiring no multiple doses or adjustments. The steps include:
The operation lasts about 2-4 hours under general anesthesia. Preoperative assessments include gastroscopy, 24-hour esophageal pH monitoring, and upper gastrointestinal imaging. Postoperative care involves dietary adjustments, with most patients resuming normal activities within 2-3 weeks.
Main advantages include:
Compared to traditional open surgery, the laparoscopic version offers:
Potential risks include:
Serious complications include:
Preoperative preparations include:
Contraindications include:
Preoperative adjustments include:
Postoperative considerations include:
Multicenter studies show:
Follow-up studies confirm:
Non-surgical options include:
Other surgical options include:
However, these alternatives have less long-term evidence supporting their efficacy compared to Nissen surgery.
Postoperative dietary recovery should be phased. The first week typically involves only clear liquids such as rice porridge or broth. In the second week, gradually introduce low-fiber semi-liquid foods (such as congee or pureed fruits), avoiding hot or cold beverages. From the third week onward, transition to soft foods and strictly avoid spicy, greasy, or hard-to-chew foods. Eating should be in small bites and slowly to prevent reflux.
Is difficulty swallowing within the first few weeks after surgery normal? When should I seek medical attention?Mild swallowing difficulty within 2-4 weeks post-surgery is common, mainly due to tissue swelling or muscle adaptation. If difficulty persists beyond six weeks, or if there is complete inability to eat solids, or if severe pain occurs, immediate medical evaluation is necessary to assess for stricture or other complications. An endoscopic dilation or other treatments may be recommended by the doctor.
When can I resume strenuous exercise or lifting heavy objects after surgery?It is generally advised to wait at least 6 weeks before engaging in strenuous activities or lifting objects over 5 kg to avoid stress on the sutures or abdominal muscles. The exact timing depends on individual recovery, and the doctor will adjust recommendations based on wound healing progress. Light activities such as walking can usually resume gradually within 1-2 weeks.
Do I need to take acid-suppressing medication long-term after surgery?Most patients can gradually reduce or stop acid-suppressing medications within 3-6 months post-surgery, depending on preoperative gastric acid secretion and postoperative follow-up results. If there was severe esophageal ulceration or recurrent reflux before surgery, short-term medication use may be recommended. Long-term follow-up is necessary, and if reflux symptoms recur, treatment strategies should be reevaluated.
What is the risk of esophageal stricture after surgery? How can it be prevented?About 5-10% of patients may develop esophageal stricture within 1-3 years postoperatively, mainly due to fibrosis and tissue contraction at the sutured site. Prevention includes strict adherence to postoperative dietary guidelines, avoiding early solid food intake, and regular endoscopic follow-up. If stricture causes swallowing difficulty, endoscopic balloon dilation can effectively relieve symptoms without the need for repeat surgery.
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