Nissen fundoplication

Also known as: fundoplication, complete fundoplication, total fundoplication, anti-reflux surgery, GERD surgery, hiatal hernia surgery

Surgery Overview
Fundoplication surgery is the most common surgery used to treat GERD and is usually performed by a general surgeon. This surgery can also repair a hiatal hernia.

During fundoplication surgery, the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place so that the lower portion of the esophagus passes through a small tunnel of stomach muscle. This surgery strengthens the valve between the esophagus and stomach (lower esophageal sphincter), which stops acid from backing up into the esophagus as easily. It relieves GERD symptoms and inflammation of the esophagus (esophagitis), which allows the esophagus to heal.

  • Full fundoplication involves wrapping the stomach around the esophagus so that it completely encircles it. Most fundoplication surgery uses the full fundoplication method.
  • Partial fundoplication involves wrapping the stomach only partway around the esophagus.

Why It Is Done
Fundoplication surgery is most often used to treat GERD symptoms that are likely to be caused in part by a hiatal hernia and that have not been well controlled by medicines. The surgery may also be used for some people who do not have a hiatal hernia. Surgery also may be an option when:

  • Treatment with medicines does not completely relieve your symptoms, and the remaining symptoms are proved to be caused by reflux of stomach juices.
  • You do not want or, because of side effects, you are unable to take medicines over an extended period of time to control your GERD symptoms, and you are willing to accept the risks of surgery.
  • You have symptoms that do not adequately improve when treated with medicines. Examples of these symptoms are asthma, hoarseness, or cough along with reflux.

How it is Done
Fundoplication surgery can be done through the abdomen or the chest. The chest approach is often used if a person is overweight or has a short esophagus.

This procedure is often done using a laparoscopic (minimally invasive) surgical technique. Outcomes of the laparoscopic technique are best when the surgery is done by a surgeon with experience using this procedure.

If a person has a hiatal hernia, which may contribute to gastroesophageal reflux disease (GERD) symptoms, it will also be repaired during this surgery.

What To Expect After Surgery
If open surgery (which requires a larger incision) is done, you will most likely spend several days in the hospital. After open surgery, you may need 4 to 6 weeks to get back to work or your normal routine.

If the laparoscopic method is used, your in-hospital stay may be reduced to 2 to 3 days. You may experience less pain after surgery because there is no large incision to heal. After laparoscopic surgery, you may need 2 to 3 weeks to get back to work or your normal routine.

After either surgery, you may need to change the way you eat. You may need to eat only soft foods until the surgery heals. And you should chew food thoroughly and eat more slowly to give the food time to go down the esophagus.

How Well It Works and Risks
All major surgery is associated with risks such as bleeding, blood clots, infection and problems with anesthesia.

Studies have shown fundoplication surgery improves GERD symptoms in most people. But, surgery may also cause new and troublesome symptoms in some people. There may be other risks associated specifically with laparoscopic fundoplication surgery. Ample surgeon experience appears to reduce complication rates and improve outcomes.

Surgery to treat GERD is rarely done on people who:

  • Are older adults, especially if they have other health problems in addition to GERD.
  • Have weak squeezing motions (peristalsis) in the esophagus. These motions are important to move food down the esophagus to the stomach. Surgery may make this problem worse, causing food to get stuck in the esophagus.
  • Have unusual symptoms that might be made worse by surgery.

In special cases, other surgeries such as partial fundoplication or gastropexy may be done instead of fundoplication surgery.

You should thoroughly discuss all treatment options with your doctor and understand the associated risks before undergoing surgery.

Learn more

Read about Providence General Surgery Services or find a general surgeon.