What is a Nissen fundoplication?

Millions of Americans are on acid reflux medication, but not many know that there is a surgery that can treat acid reflux disease. The surgery involves recreating the function of the lower esophageal sphincter (LES) by wrapping the upper portion of the stomach around the esophagus. This is called a Nissen fundoplication. Surgery is the only known cure for acid reflux. It is effective in curing acid reflux symptoms in greater than 90% of people. It has also been proven in several studies to be superior to treatment with medication alone. If you are a long-time sufferer of acid reflux disease, and/or your medication has not been effective, talk to your doctor to see if surgery is an option 

A Nissen fundoplication is a surgical procedure to treat severe gastroesophageal reflux disease (GERD). The lower esophageal sphincter helps to close off the esophagus from the stomach so that acid stays in the stomach. The Nissen fundoplication procedure involves wrapping a part of the stomach around the lower esophageal sphincter in order to make it stronger and keep stomach acid from moving backwards into the esophagus.  

The most common antireflux operation is the Nissen (360-degree) fundoplication. Also known as a stomach wrap, the operation creates a vacuum effect that prevents stomach acid from surging upward into the esophagus. Partial fundoplication, in which the stomach is wrapped only partway around the esophagus, is another option.

Nissen fundoplication involves grabbing a portion of the top of the stomach and looping it around the lower end of the esophagus and lower esophageal sphincter (LES)—the muscle connecting the esophagus and stoma—to create an artificial sphincter or pinch valve. It prevents stomach acid from backing up into the esophagus. The wrap must be tight enough to prevent the acid from coming back up, but not so tight that food can't enter and a satisfying belch can't escape.

Over time, however, the stomach wrap can loosen. When that happens, the patient may need to resume medications and, in a small number of cases, undergo surgery to redo the procedure. A study in The Journal of the American Medical Association found that 62% of patients who had undergone the Nissen fundoplication procedure 10 years earlier were regularly using medications to control reflux.

Most surgeons now perform fundoplication as a laparoscopic procedure, in which special instruments and cameras are inserted into tiny incisions in the upper abdomen. Patients recover much faster from laparoscopy than from open surgery.

"Nissan Fundoplication" involves “wrapping the stomach around the esophagus.”

The deal is that the lower esophageal sphincter, or LES, valve is lax, and allows the acid to flow up the esophagus and injure the lining. Your surgeons plan to take the very top part of the stomach, called the fundus, and actually flop it around the lower esophagus and staple it in position.

After you eat, your food goes down the esophagus and into the fundus, filling the fundus up and thus compressing the lower esophagus area. The newly made valve mechanically keeps the food and acid in the stomach, and prevents back flow.