Diagram of a Nissen fundoplication.

Image from laparoscopic Nissen Fundoplication - Pointing upwards towards the chest from the abdomen area. The three stitches next to the liver are closing up the hiatus (hole where esophagus passes through the diaphram), and the three stitches in the stomach secure the wrap (around the esophagus).

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 in particular types of hiatus hernia (the paraoesophageal variant), it is the first-line procedure. A partial fundoplication may accompany surgery for achalasia (specifically, a Heller myotomy). Image File history File links No higher resolution available. ... Image File history File links No higher resolution available. ... Surgical procedures have long and possibly daunting names. ... Gastroesophageal Reflux Disease (GERD; or GORD when spelling Å“sophageal, the BrE form) is defined as chronic symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus[1]. This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. ... A hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. ... A hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. ... Achalasia, also known as esophageal achalasia, achalasia cardiae, cardiospasm, dyssynergia esophagus, and esophageal aperistalsis, is an esophageal motility disorder. ... Heller myotomy is a form of laparoscopic surgery that is considered minimally invasive. ...

The procedure

In fundoplication, the fundus (upper part) of the stomach is wrapped, or plicated, around the inferior part of the esophagus, preventing the reflux of gastric acid (in GERD) or preventing the sliding of the fundus through the enlarged hiatus in the diaphragm. In a Nissen fundoplication, also called a complete fundoplication, the fundus is wrapped all the way around the esophagus. In anatomy, the stomach (in ancient Greek στόμαχος) is an organ in the alimentary canal used to digest food. ... In anatomy, the stomach is a bean-shaped hollow muscular organ of the gastrointestinal tract involved in the second phase of digestion, following mastication. ... The esophagus (also spelled oesophagus/Å“sophagus, Greek ), or gullet is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. ... Gastric acid is, together with several enzymes and the intrinsic factor, one of the main secretions of the stomach. ... In the anatomy of mammals, the diaphragm is a shelf of muscle extending across the bottom of the ribcage. ...

Surgery for achalasia is generally accompanied by a partial fundoplication, either Dor and Toupet. 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. Achalasia, also known as esophageal achalasia, achalasia cardiae, cardiospasm, dyssynergia esophagus, and esophageal aperistalsis, is an esophageal motility disorder. ...

The procedure is often done laparoscopically. Laparoscopic surgery, also called keyhole surgery (when natural body openings are not used), bandaid surgery, or minimally invasive surgery (MIS), is a surgical technique. ...

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. From Greek pylorus; pyl- = gate, -orus = guard. ...

Complications

Complications include gas bloat syndrome, dysphagia (trouble swallowing), dumping syndrome, excessive scarring, and rarely, achalasia. The procedure can also become undone over time, 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. After a Nissen fundoplication surgery, individuals are unable to belch. ... Dysphagia () is a medical term defined as difficulty swallowing. ... The dumping syndrome, or rapid gastric emptying, happens when the lower end of the small intestine fills too quickly with undigested food from the stomach. ... Achalasia, also known as esophageal achalasia, achalasia cardiae, cardiospasm, dyssynergia esophagus, and esophageal aperistalsis, is an esophageal motility disorder. ... Marlex is a trademarked name for crystalline polypropylene and high-density polyethylene (HDPE). ...

History

Dr. Rudolph Nissen first performed the procedure in 1951, and the procedure therefore bears his name. 1951 (MCMLI) was a common year starting on Monday; see its calendar. ... An eponym is the name of a person, whether real or fictitious, who has (or is thought to have) given rise to the name of a particular place, tribe, discovery, or other item. ...

Related Problems *** Jfdwolff...please read discussion next time u delete ***

The Nissen Fundo procedure spirals the top portion of the stomach around the bottom portion of the esophagus and sutures it in place. The reason that this creates a one way valve is because when the entire stomach muscle shortens or contracts it pulls against the spiraled sutured portion causing it to tighten up and close off access to the stomach during this stomach muscle contraction. However in between stomach contractions the access is open allowing food and liquid to come down and enter the stomach. When the stomach contracts it either pushes stomach contents up or down. Since the "nissened" stomach closes off access to the esophagus durring this contraction the contents can only be pushed down thereby preventing reflux under normal circumstances.

However if a feeding tube is hooked up to the patient, it can force or push the feeding into the stomach and up the esophagus, in between stomach contractions, when access from the stomach to the esophagus is open. This can cause an overfilling of the stomach thereby potentially sending stomach acid and contents up and allowing it to migrate or enter the lungs durring breathing. Stomach compacity itself is decreased because of the Nissen Fundoplication, making overfilling of the stomach even more likely. Even a little Stomach acid and food contents in the lungs can dammage lung tissue and cause respiratory asthmatic like symptoms. The lungs may try to clean and repair themselves between feeding tube feedings, only to be damaged again during the next feeding where stomach overfilling occurs again creating a syndrome of continued or even worsening respitory symptoms.

This Pump induced overfilling of the stomach will not show up on typical refux tests where the feeding tube is disconnected and formula is given orally and all the mechanisms that help cause a stomach contraction are in place such as salivation, swallowing etc. A feeding tube bypasses some of these mechanisms pumping formula directly into the stomach.

High pressure in the feeding tube lines between the pump and the stomach can also keep the stomach from contracting properly, making overfilling of the stomach more likely.

If a monitor which uses an electric current to moniter vital signs is connected near the stomach it can cause the stomach to not contract properly. When an electric current traveles across a muscle it causes the muscle to slightly contract. This slightly contracted muscle is more likely not to contract properly. This effect is greatly increased with premature infants in an NICU unit where vital signs must be monitered.

I hope this information is useful to others with similar problems because this information is not common knowledge.

External links

• Laparoscopy teaching site (WARNING: contains surgery footage).
• Nissen fundoplication videos on google video