Laparoscopic Nissen Fundoplication Surgery for the Treatment of Acid Reflux performed live at Tampa General Hospital, Tampa, FL.
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Alexander Rosemurgy, MD, FACS, Professor of Surgery at the University of South Florida and a surgeon at Tampa General Hospital presented live over the internet a Laparoscopic Nissen Fundoplication. This procedure is an excellent long-term treatment option for acid reflux, commonly referred to as ‘heartburn.’ Michael Albrink, MD, FACS, Associate Professor of Surgery at the University of South Florida and a surgeon at Tampa General Hospital, narrated the procedure.

With the patient under general anesthesia, surgeons use 5 half-inch incisions to enter the abdomen through cannulas (narrow tube-like instruments). The laparoscope, which has a tiny video camera, is inserted through a small incision allowing the surgeon to view the patient’s internal organs on a TV screen.

During the procedure the stomach is configured to form a ring around the esophagus – similar to the placement of a napkin ring – which will function as a valve between the esophagus and the stomach.

Prior to the development of this laparoscopic procedure, surgeons had to make a large abdominal incision and recovery time was extensive. The Laparoscopic Nissen Fundoplication reduces recovery time and in the vast majority of cases eliminates the need for acid reflux medication.

The Surgical Digestive Disorders and Gastrointestinal Cancers Program at Tampa General Hospital recently received disease-specific certification from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

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A live webcast originating from the “Operating Room of the Future” at the University of Maryland Medical Center in Baltimore showed minimally invasive surgery to treat a serious form of heartburn, called gastroesophageal reflux disease (GERD).

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During the procedure, a laparoscopic Nissen fundoplication, surgeons made five small incisions and used a laparoscope (a long, thin instrument that contains a video camera) to repair the lower esophageal sphincter, a muscle that separates the stomach and esophagus. Normally, that muscle closes after a person eats or drinks to keep food and stomach acids from returning up into the esophagus. But in people who experience chronic reflux, the muscle does not stay closed tightly or is unable to close properly, and they have heartburn, chest pain, cough, difficulty swallowing or regurgitation. Left untreated, reflux can lead to serious complications, including esophageal ulcers or bleeding.

Gastroesophageal Reflux Disease

“The beauty of this procedure is that we make the repair using the patient’s own anatomy,” says Adrian E. Park, M.D., head of General Surgery at the University of Maryland Medical Center and professor of surgery at the University of Maryland School of Medicine.

“In this procedure, we wrap a part of the stomach known as the gastric fundus around the lower esophagus, which prevents the flow of acid back into the esophagus,” adds Dr. Park, who will perform the surgery during the live webcast.

J. Scott Roth, M.D., head of surgical endoscopy at the University of Maryland Medical Center and a faculty member of the University of Maryland School of Medicine, explained the progress of the operation during the live webcast, and provided background information about the procedure.

Paul Castellanos, M.D., assistant professor of surgery at the University of Maryland School of Medicine and medical director of the Center for Voice, Swallowing and Esophageal Disorders at the University of Maryland Medical Center, will also be in the operating room during the webcast. Dr. Castellanos is an otolaryngologist who works closely with Dr. Park. He practices the subspecialty of laryngology along with head and neck surgery. He has coined the term “Laryngopharyngeal Extra-esophageal Reflux Disease,” or LERD, as an entity related to GERD but often the source of puzzlement to clinicians because these patients have reflux related throat disease without commonly having heartburn. They do not often have abnormalities of the lower esophagus such as erosions, ulcerations, strictures or Barrett’s esophagus, a premalignant condition related to GERD.

“Patients with LERD are often misdiagnosed and can have their condition progress to permanent voice loss, airway strictures, lung disease and even head and neck cancer,” explains Dr. Castellanos.

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This is a replay of the live Internet broadcast, which allows a bedside view in an operating room at The Nebraska Medical Center.

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The surgery is designed to stop painful acid reflux disease. The procedure tightened the valve that allows food to pass through the esophagus into the stomach. Because the procedure is done laparoscopically, an internal camera takes you from inside the operating room to inside the body.

“Called a Nissen fundoplication, the procedure prevents acid reflux from coming back up into the esophagus,” said surgeon Dmitry Oleynikov, M.D. “Ninety-five per cent of the patients who have this surgery will not experience acid reflux again,” Dr. Oleynikov said.

The laparoscopic “Nissen” as it’s called, is much easier on patients than the traditional operation. Dr. Oleynikov performs the surgery using only four small incisions. It requires a 23-hour hospital stay and only a week out of the office. When not performed laparoscopically, patients stay in the hospital for 3 to 5 days and take six weeks off of work.

“People tend to suffer from reflux disease and they don’t have to,” Dr. Oleynikov said. “Left untreated, it can lead to Barrett’s esophagus, which is a precursor to cancer. Only surgery can reverse Barrett’s,” explained Dr. Oleynikov, who recently authored a paper on the subject.

Candidates for the surgery include people who have reflux more than four to five times a week that is not eased by medication, or have documented problems with their esophageal sphincter.

Acid reflux hits a bigger segment of the population than you might think. Just walk down any street in any city in the United States and you will see the faces of people who live with acid reflux. Sometimes it takes the form of mild heartburn, but sometimes that heartburn is a symptom of the larger problem called Gastroesophageal Reflux Disease or GERD.

There are all kinds of over-the-counter and prescription medications that are used to treat GERD and often antacids are the first course of treatment. For some people, medications stop doing the trick leaving them with frequent and often painful acid reflux. That’s when surgery becomes a viable option.

Symptoms of GERD include: heartburn, regurgitation of gastric acid or sour contents into the mouth; difficult and/or painful swallowing and chest pain. Most people assume that food triggers GERD but that’s not usually the case. In fact, stress appears to be a bigger trigger than spicy food.

“While just about everyone will have heartburn at some time or another, GERD is much worse. It is a nagging, persistent burning in the chest that can be mistaken for a heart attack. When you experience GERD more than five times a week and over-the-counter medications are no longer bringing you relief, it is time to see a doctor,” Dr. Oleynikov said.

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