November 9, 2019

Laparoscopic / Robotic Nissen Fundoplication (for GERD): What You Need to Know

Gastroesophageal reflux disease (GERD) is a commondigestive diseaseaffecting nearly 20% of American men and women at any age. Most people manage their symptoms effectively with lifestyle changes and medications. However, for others, these treatments only provide temporary relief and surgery may be the best next option.

What is GERD?

GERD is a condition developed when the reflux of the stomach contents causes symptoms so adverse they affect an individual’s well-being and daily life.

For most, after swallowing, the valve between the esophagus and stomach opens, allowing food to pass, and then closes to prevent stomach contents from moving back up into the esophagus. However, for those suffering from GERD, there is a failure in this lower valve. Acid is then free to reenter the esophagus, creating a burning sensation that irritates the lining and causes damage.

Such valve failure can be the result of weakened muscles of the esophageal valve because of obesity, pregnancy, certain medications, smoking or secondhand smoke. GERD can also be caused by a hiatal hernia in the area of the esophagus in which the stomach bulges through an opening in the diaphragm.

Is it heartburn or GERD?

Most people experience acid reflux from time to time. Certain foods and other conditions can exacerbate the acid in the stomach which can then flow upward into the esophagus and throat.

GERD, however, is usually diagnosed when acid reflux occurs at least twice a week or severe reflux occurs at least once every week.

The most common symptoms of GERD include:

  • Heartburn and acid reflux most often occuring 30 to 60 minutes after eating that worsens at night
  • Chest pain
  • Difficulty swallowing or the feeling of a lump in the throat
  • Hoarseness, laryngitis and/or sore throat
  • Persistent dry cough
  • Wheezing
  • Asthma or asthma-like symptoms
  • Pneumonia
  • Dental erosions, gum disease and inflammation
  • Nausea and/or vomiting

GERD treatment options

Treatment options often depend on the severity of symptoms, age and overall health, but most find relief from GERD symptoms with lifestyle changes and medication. Weight loss, inclined positions to elevate the head, avoidance of intolerable foods, and tobacco and alcohol cessation are most often recommended as beginning steps in treatment.

Medications such as antacids and antisecretory agents are available over the counter or by prescription. These medications may be necessary for long-term, continuous treatment, and because of this, there is a chance they can lose their effectiveness over time. In addition, even though these medications are effective for most patients, they don’t necessarily treat the underlying cause of reflux.

If lifestyle changes and medication do not alleviate symptoms, or if troublesome symptoms continue despite high doses of medication, further damage can result, and surgery may be the best next option. Surgical intervention is generally suggested for patients with:

  • Inadequate symptom control with medication or side effects
  • An inability to tolerate, or unwilling to take lifelong medications
  • Severe complications of GERD such as asthma, aspiration or chest pain

Find GERD relief with robot-assisted Nissen fundoplication

With a long record of exceptional results, Nissen fundoplication is the most commonly performed antireflux surgery and can be performed for nearly any patient suffering severe GERD symptoms.

A Nissen fundoplication attempts to recreate the valve at the lower esophagus by tightening the upper portion of the stomach around the esophagus and sewing it into place. This tightening decreases the incidence of reflux by recreating the valve with the patient’s own stomach tissue.

New advancements in minimally invasive surgeries have led to the use of robotic systems like the da Vinci surgery system for Nissen fundoplications. A robotic assisted surgery uses small incisions—about 1-2 cm—to allow specially designed, wristed instruments and a 3D camera to enter the abdomen. This advanced technology allows surgeons to control the instruments with 540 degree range of motion while being guided with magnified, high-definition imagery of the surgery site.

With the use of the da Vinci robotic surgery system, national leading surgeons like Dr. Andrea Pakula are able to perform Nissen fundoplication surgeries with revolutionary dexterity and control, while affording patients the benefits of fewer complications during surgery and less postoperative issues after surgery. Patients will have:

  • Shorter surgery time—about 1 to 2 hours
  • Less postoperative pain
  • Reduced trauma to the body
  • Less scarring
  • Shorter hospital stay
  • Reduced blood loss
  • Quicker recovery and return to normal activity

What to expect after surgery

After surgery, most patients are anxious to get back to normal life and activities. In most cases, patients resume normal day-to-day routines within the first week.

As the esophagus heals, patients are on a liquid diet for the first week, helping to control breathing issues and excess gas after the procedure. There may be tenderness or pain in the incision sites and difficulty swallowing immediately after surgery.

As everyone heals differently, it is important to follow the guidelines set by the medical team after surgery.

Risks and concerns

While most people find great success after Nissen fundoplication, like with any surgery, there are risks and concerns that may arise. Some risk factors include:

  • Injury to nearby tissues or organs
  • Difficulty swallowing
  • Pneumonia
  • Bleeding
  • Infection
  • Internal scarring
  • Temporary pain or nerve injury
  • Blood clot

Choose the right surgeon for your needs

Dr. Andrea Pakula is a national leader in robotic surgery and trains surgeons all over the country in various types of robotic surgery.

Minimally invasive robot-assisted surgery is grounded in the desire to overcome the limitations of current laparoscopic technologies and expand the benefits gained by patients.ContactDr. Pakula today and start to enjoy life again!

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