Nissen fundoplication for severe acid reflux

A Nissen fundoplication is surgery to treat severe and ongoing acid reflux.

Acid reflux is when the acid in your stomach flows back into your food pipe (oesophagus). This irritates the lining of the oesophagus and causes a burning sensation. This can be known as heartburn.

Acid reflux that keeps happening is called gastro-oesophageal reflux disease (GORD).

This happens because the muscular valve (sphincter muscle) between your oesophagus and stomach does not work properly.

The surgery is usually keyhole (laparoscopic) surgery. This means the surgeon will not make any large incisions in your skin.

We wrap the top part of your stomach around the lower part of your oesophagus. This makes a new valve.

Who can have a Nissen fundoplication

A Nissen fundoplication helps ongoing reflux symptoms that cannot be controlled with medicine or lifestyle changes.

You will need some tests to diagnose the condition, or procedures to rule out other causes for your symptoms before you can have this surgery.

A Nissen fundoplication is reversible through a second operation.

Nissen fundoplication to treat a hiatus hernia

If part of your stomach slides up into your chest (hiatus hernia), this can also cause GORD symptoms. A hiatus hernia will be repaired during Nissen fundoplication surgery. Permanent stitches are used for the hiatus repair, and to keep the stomach in place.

Risks of a Nissen fundoplication

All types of surgery have a risk of problems and side effects.

Risks of a Nissen fundoplication include injury to the oesophagus, stomach, blood vessels or nearby organs. The surgeon might change to open surgery to repair any damage. However, these complications are rare.

You might need corrective surgery if you have problems swallowing after surgery, or bloating that is not getting better. This happens in about 2 in every 100 cases (2% of people).

In some cases, the surgery might need to be repeated if the new valve slips or becomes loose.

If you are being sick (vomiting) or retching a lot after surgery, there's a risk you might develop:

  • a hernia that keeps happening
  • movement of the new valve

This might need to be repaired by more surgery.

It is important to carefully follow the advice about diet after surgery

You should also take any anti-sickness medicine you are given to reduce these risks.

Other treatment options

Another option is to keep taking medicine known as proton pump inhibitor (PPI) to manage your symptoms. Before you are offered Nissen fundoplication surgery, these medicines will have been discussed with you and you will have taken them.

Medicines known as antacids can also help acid reflux symptoms.

You can also make dietary changes to try and help manage your symptoms. Lifestyle changes that can help symptoms include:

  • stopping smoking
  • exercising more
  • losing weight

Read more about the vital 5 ways to stay healthy and how to make lifestyle changes.

Changes to your diet

Having smaller, more frequent meals puts less pressure on the valve that connects your oesophagus and stomach.

Having less of certain foods can also help. For example, having less:

  • coffee or tea
  • fizzy drinks
  • alcohol
  • citrus fruits
  • tomatoes
  • chocolate
  • mint or peppermint
  • fatty foods
  • spicy foods
  • onions and garlic

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves.

If you would like more information about our consent process, please speak to a member of staff caring for you.

Resource number: 4855/VER2
Last reviewed: June 2022
Next review due: June 2025

Contact us

If you have any questions or concerns about Nissen fundoplication, please contact the benign upper GI clinical nurse specialist.

Phone: 020 7188 2673 Monday to Friday, 9am to 5pm.

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