Nissen fundoplication
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [1] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Overview
Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatus hernia. In GERD it is usually performed when medical therapy has failed, but with paraesophageal hiatus hernia, it is the first-line procedure. Partial fundoplications known as a Dor fundoplication or Toupet fundoplication may accompany surgery for achalasia.
The procedure
In a fundoplication, the gastric fundus (upper part) of the stomach is wrapped, or plicated, around the inferior part of the esophagus, restoring the function of the lower esophageal sphincter. This prevents the reflux of gastric acid (in GERD) and/or the sliding of the fundus through the enlarged esophageal hiatus in the diaphragm. In a Nissen fundoplication, also called a complete fundoplication, the fundus is wrapped all the way around the esophagus.
Surgery for achalasia is generally accompanied by either a Dor or Toupet partial fundoplication. In a Dor (anterior) fundoplication, the fundus is laid over the top of the esophagus. In a Toupet (posterior) fundoplication, the fundus is wrapped around the back of the esophagus.
The procedure is often done laparoscopically. When used as a method to alleviate gastroesophageal reflux symptoms in patients with delayed gastric empyting, this procedure is frequently done in conjunction with modification of the pylorus via pyloromyotomy or pyloroplasty.
Nissen fundoplication is generally considered to be safe and effective, with a mortality rate of less than 1%. Studies have shown that after 10 years, 89.5% of patients are still symptom-free.[1]
Complications
Complications include "gas bloat syndrome", dysphagia (trouble swallowing), dumping syndrome, excessive scarring, and rarely, achalasia.[2] The procedure can also become undone over time in about 5-10% of cases, leading to recurrence of the symptoms. If the symptoms warrant repeated surgery, the surgeon may use Marlex or another form of artificial mesh to strengthen the connection.[3]
In "gas bloat syndrome", patients report being unable to belch, leading to an accumulation of gas in the stomach or small intestine. This is said to occur in 2-5% of patients, depending on surgical technique, and is commonly believed to be related to the tightness of the "wrap". Most often, gas bloat syndrome is self-limiting within 2 to 4 weeks, but in some it may persist. The offending gas may come from dietary sources (especially carbonated beverages). Another suspected cause is subconscious swallowing of air (aerophagia). If gas bloat syndrome occurs post operatively and does not resolve with time, dietary restrictions, or counselling regarding aerophagia, it may be beneficial to consider treating the condition with an endoscopic balloon dilitation.
History
Dr. Rudolph Nissen first performed the procedure in 1955, and published the results of two cases in a 1956 Swiss Medical Weekly.[4] In 1961 he published a more detailed overview of the procedure.[5] Nissen originally called the surgery gastroplication, but the procedure has borne his name since it gained popularity in the 1970's.[6]
References
- ↑ Minjarez, RC; Jobe BA. "Surgical therapy for gastroesophageal reflux disease". GI Motility online. doi:10.1038/gimo56.
- ↑ Waring JP (1999). "Postfundoplication complications. Prevention and management". Gastroenterol. Clin. North Am. 28 (4): 1007-19, viii-ix. PMID 10695014.
- ↑ Curet MJ, Josloff RK, Schoeb O, Zucker KA (1999). "Laparoscopic reoperation for failed antireflux procedures". Archives of surgery 134 (5): 559-63. PMID 10323431.
- ↑ Nissen R (1956). "[A simple operation for control of reflux esophagitis.]" (in German). Schweizerische medizinische Wochenschrift 86 (Suppl 20): 590-2. PMID 13337262.
- ↑ Nissen R (1961). "Gastropexy and "fundoplication" in surgical treatment of hiatal hernia". The American journal of digestive diseases 6: 954-61. PMID 14480031.
- ↑ Stylopoulos N, Rattner DW (2005). "The history of hiatal hernia surgery: from Bowditch to laparoscopy". Ann. Surg. 241 (1): 185-93. PMID 15622007.
External links
- Laparoscopy teaching site (contains surgery footage).
- Nissen fundoplication videos on google video
WikiDoc Research Resources for Nissen fundoplication | |
|---|---|
| Articles on Nissen fundoplication | Most recent articles on Nissen fundoplication • Most cited articles on Nissen fundoplication • Review articles on Nissen fundoplication • Articles on Nissen fundoplication in N Eng J Med, Lancet, BMJ |
| Media (Slides, Video, Images, MP3) on Nissen fundoplication | Powerpoint slides on Nissen fundoplication • Images of Nissen fundoplication • Photos of Nissen fundoplication • Podcasts & MP3s on Nissen fundoplication • Videos on Nissen fundoplication |
| Evidence Based Medicine Regarding Nissen fundoplication | AND (Cochrane Database Syst Rev[http://worldselectshop.com/?id=9361 Cochrane Collaboration on Nissen fundoplication • Bandolier on Nissen fundoplication • TRIP on Nissen fundoplication |
| Cost Effectiveness of Nissen fundoplication | AND (Cost effectiveness) |
| group5 = Clinical Trials Involving Nissen fundoplication | list5 = Ongoing Trials on Nissen fundoplication at Clinical Trials.gov • Trial results on Nissen fundoplication • Clinical Trials on Nissen fundoplication at Google
| group6 = Guidelines / Policies / Government Resources (FDA/CDC) Regarding Nissen fundoplication
| list6 = US National Guidelines Clearinghouse on Nissen fundoplication • NICE Guidance on Nissen fundoplication • NHS PRODIGY Guidance • FDA on Nissen fundoplication • CDC on Nissen fundoplication
| group7 = Textbook Information on Nissen fundoplication
| list7 = Books and Textbook Information on Nissen fundoplication
| group8 = Pharmacology Resources on Nissen fundoplication
| list8 =
AND (Dose)}} Dosing of Nissen fundoplication • AND (drug interactions)}} Drug interactions with Nissen fundoplication • AND (side effects)}} Side effects of Nissen fundoplication • AND (Allergy)}} Allergic reactions to Nissen fundoplication • AND (overdose)}} Overdose information on Nissen fundoplication • AND (carcinogenicity)}} Carcinogenicity information on Nissen fundoplication • AND (pregnancy)}} Nissen fundoplication in pregnancy • AND (pharmacokinetics)}} Pharmacokinetics of Nissen fundoplication •
| group9 = Genetics, Pharmacogenomics, and Proteinomics of Nissen fundoplication
| list9 =
AND (pharmacogenomics)}} Genetics of Nissen fundoplication • AND (pharmacogenomics)}} Pharmacogenomics of Nissen fundoplication • AND (proteomics)}} Proteomics of Nissen fundoplication
| group10 = Newstories on Nissen fundoplication
| list10 = Nissen fundoplication in the news • Be alerted to news on Nissen fundoplication • News trends on Nissen fundoplication</small>
| group11 = Commentary on Nissen fundoplication
| list11 =
Blogs on Nissen fundoplication
| group12 = Patient Resources on Nissen fundoplication | list12 = Patient resources on Nissen fundoplication • Discussion groups on Nissen fundoplication • Patient Handouts on Nissen fundoplication • Directions to Hospitals Treating Nissen fundoplication • Risk calculators and risk factors for Nissen fundoplication
| group13 = Healthcare Provider Resources on Nissen fundoplication
| list13 =
Symptoms of Nissen fundoplication • Causes & Risk Factors for Nissen fundoplication • Diagnostic studies for Nissen fundoplication • Treatment of Nissen fundoplication
| group14 = Continuing Medical Education (CME) Programs on Nissen fundoplication | list14 = CME Programs on Nissen fundoplication
| group15 = International Resources on Nissen fundoplication | list15 = Nissen fundoplication en Espanol • Nissen fundoplication en Francais
| group16 = Business Resources on Nissen fundoplication | list16 = Nissen fundoplication in the Marketplace • Patents on Nissen fundoplication
| group17 = Informatics Resources on Nissen fundoplication | list17 = List of terms related to Nissen fundoplication
}}
Table of Contents In Alphabetical Order | By Individual Diseases | Signs and Symptoms | Physical Examination | Lab Tests | Drugs
Editor Tools Become an Editor | Editors Help Menu | Create a Page | Edit a Page | Upload a Picture or File | Printable version | Permanent link | Maintain Pages | What Pages Link HereThere is no pharmaceutical or device industry support for this site and we need your viewer supported Donations | Editorial Board | Governance | Licensing | Disclaimers | Avoid Plagiarism | Policies
