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1. What is the meaning of the name of this procedure ?
Nissen is the last name of a surgeon who described this technique several years
ago. Fundoplication refers to the fundus of the stomach, (the upper portion) which is sewn to itself (plication) to
form the wrap around the lower esophagus.
2. Do all people with reflux have hiatal hernias and visa
versa?
No. Many people with reflux do not have hiatal hernia or only a
very small one. Equally, a hiatal hernia, even a large one may be completely without symptoms.
If a hiatal hernia is present, it will be repaired at the time of this operation.
3. How many
and how often does Dr. Chengelis perform this procedure?
He does this procedure frequently,
approximately 40 per year with numbers increasing of late. Results have been excellent with no major complications
and no deaths. He has not needed to convert a patient to an open procedure as yet.
4. What
are some of the risks of the procedure ?
A small perforation of the stomach or esophagus
and/or bleeding are two of the more serious potential complications. Fortunately, both are very rare. Discussion
with the surgeon will review other risks.
5. How long does the operation take to complete ?
Actual surgery time is about one hour or so. Like all laparoscopic operations, it requires
general anesthesia. Actual time in the operating room is closer to two hours.
6. How
many days in the hospital ?
Most patients can go home the next day.
7. What is the recovery time at home?
Most patients are recovered
in about a week after which they can resume most activities such as driving, light exercise, work.
8.
What is the care of the incisions ?
The small incisions are closed with absorbable
suture beneath the skin and covered with paper tapes which remain for about two weeks. You can shower and wet the tapes
one day after surgery.
9. How long does the wrap last ?
Ideally,
the surgery is permanent. A small percentage of patients might experience a slip wrap (when the stomach slips
above the wrap) or a herniated wrap (when the entire wrap herniates through a recurrent hiatal hernia. ) Recurrent
reflux, pain, emesis are usual symptoms.
10. Will I need to take my reflux medications after the
surgery ?
No. One of the the reasons to have the surgery is to remove the need
to take expensive reflux medications for the rest of your life. Studies have shown about one in 5 patients do resume
their medication after a year but unlike pre surgery, the medication is able to control the reflux symptoms. A
majority of poeple will not need medication again and experience dramatic improvement in their lives with resolution of the
reflux pain.
11. What can I eat after the surgery ?
This is very important. Liquids (no carbonation) only for the first two weeks! This is done to prevent
any food blockage in the lower esophagus where swelling can take place from the surgery. Long term, most foods are ok.
12. Any other long term issues ?
Some people will not be able
to burp whch can cause a bloating senation in the stomach area. Increased flatuence can also result.
13. What is Barrett's Esophagus?
Reflux
can damage the lower esophagus and cells can transform into a different type of cell. This can lead even further
changes and eventually cancer. Factors such as tobacco use and alcohol can increase the potential for cancer.
Once Barretts is diagnosed, by upper endoscopy, it needs to be periodically biopsied to closely watch in case early cancer
changes do take place. This is true even if one has reflux surgery. Some studies do show reduction
in Barretts after surgery and decrease in cancer as well vs medical treatment.
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