What Is Nissen Fundoplication?
Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD) and symptomatic hiatal hernias that don’t respond well to medical therapy. It works by reinforcing the lower esophageal sphincter (LES) — the valve that prevents stomach acid from flowing back into the esophagus — thereby reducing heartburn, regurgitation, and other reflux symptoms.
Why Surgery Is Performed
Nissen fundoplication is recommended when:
- GERD symptoms persist despite lifestyle changes and medications
- A hiatal hernia contributes to chronic reflux
- There are complications from reflux, such as esophagitis or Barrett’s esophagus
- Patients wish to reduce or eliminate the need for long‑term acid suppressants
The procedure restores a barrier at the top of the stomach to help keep acid and stomach contents where they belong.
How Nissen Fundoplication Works
During a Nissen fundoplication, the upper portion of the stomach (the fundus) is wrapped 360° around the lower esophagus. This tighter flap increases pressure at the LES, helping to prevent acid reflux. The surgery is most often performed using minimally invasive techniques, including laparoscopy or robotic assistance, which involve smaller incisions, less pain, and faster recovery compared with open surgery.
What to Expect During Surgery
Nissen fundoplication is performed under general anesthesia in a hospital or surgical center. The surgeon makes several small incisions in the abdomen to access the hiatal area. Specialized instruments and magnified visualization allow precise dissection and placement of the fundic wrap around the lower esophagus. The procedure typically takes a couple of hours, and most patients go home within 24–48 hours.
Recovery and Aftercare
After surgery, patients generally experience relief from reflux symptoms and can begin a diet that progresses gradually from liquids to soft foods over the course of weeks. Key elements of recovery include:
- Pain control and incision care
- Meal progression under your care team’s guidance
- Avoiding heavy lifting and strenuous activity during early healing
- Walking and light activity to promote circulation
Swallowing difficulty or bloating may occur early after surgery but tends to improve with time and dietary adjustments.
Benefits of Nissen Fundoplication
- Reduction or elimination of GERD symptoms
- Improved quality of life without long‑term medication
- Correction of associated hiatal hernia
- Long‑term control of reflux compared with medical therapy alone
Risks and Considerations
As with any surgery, risks include bleeding, infection, injury to surrounding structures, complications related to anesthesia, and difficulty swallowing (dysphagia). Some patients may develop gas‑bloat syndrome, where they have trouble belching or feel bloated. Your surgeon will explain risks specific to your health profile and how they plan to minimize them.
