Laparoscopic Nissen Fundoplication Surgery for the Treatment of Acid Reflux

Laparoscopic Nissen Fundoplication Surgery for the Treatment of Acid Reflux performed live at Tampa General Hospital, Tampa, FL.
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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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Minimally Invasive Surgery to Correct GERD

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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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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Acid Reflux Surgery Live on the Internet

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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“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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Laparoscopic Nissen Fundoplication Surgery

Laparoscopic Nissen Fundoplication Surgery is the the standard surgical treatment for GERD, which strengthens the sphincter and prevents acid reflux. Recorded at Our Lady of the Lake Regional Medical Center Baton Rouge, LA.

Laparoscopic nissen fundoplication is a minimally invasive procedure to correct gastroesophagel reflux disease (GERD). This procedure alleviates chronic heartburn in people whose condition cannot be controlled by either lifestyle changes or medication. Symptoms include a burning sensation from the chest to the throat which is caused by severe gastroesophageal reflux due to a weak valve muscle between the stomach and the esophagus.

Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. The esophagus carries food from the mouth to the stomach.

When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD and it can eventually lead to more serious health problems.

Anyone, including infants, children and pregnant women, can have GERD. The main symptoms are persistent heartburn and acid regurgitation; however some people have GERD without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. Other symptoms include the felling that food is caught in the throat, the feeling of choking or a tight throat. GERD can also cause a dry cough and bad breath.

G.E.R.D. Facts and Nissen Fundoplication

G.E.R.D. Facts

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This is a 63 minute video of a Nissen Fundoplication surgery recorded live in Nebraska Medical Center. RealOne player will open in a new window, which you can drag anywhere on your monitor. Download the Free RealOne Player.

• GERD stands for Gastro Esophageal Reflux Disease, or the backflow of stomach acid into the swallowing tube, or esophagus. This acid can irritate and sometimes damage the delicate lining inside the esophagus.

• GERD occurs when a muscle at the lower end of the esophagus, called the lower esophageal sphincter, does not work properly and allows stomach contents to back up into the esophagus.

• More than 7 million Americans suffer from GERD.

• The number of GERD cases in the United States is growing.

• GERD afflicts people of every socioeconomic class, ethnic group and age. However, incidences of the disease increase dramatically in people over age 40. More than 50 percent of people who suffer from GERD are between the ages of 45 and 64.

• Symptoms include:

• Frequent heartburn
• Regurgitation of gastric acid or partially digested food into mouth
• Difficult or painful swallowing
• Chest pain

• Left untreated, GERD can develop into Barretts’ esophagus, a condition that is often a precursor to esophageal cancer.

• Esophageal cancer is one of the fastest growing cancers in the U.S.

• A surgical procedure called the laparoscopic Nissen Fundoplication can correct GERD and often reverse the damage it causes, including Barrett’s esophagus.

G.E.R.D. Surgery Facts

• A surgical procedure called Nissen Fundoplication is used to correct GERD by physically preventing stomach acid from backing up into the esophagus.

• The surgery involves constructing a new “valve” between the esophagus and the stomach by wrapping the upper portion of the stomach around the lowest part of the esophagus. As the stomach becomes distended during a meal, the wrap compresses the lower esophagus, preventing reflux.

• Candidates for surgery have heartburn at least four to five times a week and have documented problems with the sphincter muscle at the lower of the esophagus.

• The surgery can be done laparoscopically, requiring only four small cuts instead of one big incision that can take several weeks to heal.

• The laparoscopic surgery requires a 23-hour hospital stay. Patients go home able to eat and drink, but are told to avoid foods that are difficult to swallow for another two weeks.

• Most patients are able to return to office duties about a week after the surgery and perform more strenuous work in about two weeks.

• More than 90 percent of patients will not suffer from acid reflux again.

• The best “treatment” for esophageal cancer is prevention. Surgery can reverse Barrett’s Esophagus, which is a precursor to cancer.