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 food pipe and causes a burning feeling called heartburn.
If you keep getting acid reflux, the condition is called gastro-oesophageal reflux disease (GORD). This happens because the muscle valve (sphincter muscle) between your food pipe and stomach does not work properly.
You usually have keyhole (minimally invasive or laparoscopic) surgery. This means that the surgeon does not make any large cuts in your skin.
We wrap the top part of your stomach around the lower part of your food pipe. This makes a new valve.
Who can have a Nissen fundoplication
A Nissen fundoplication helps ongoing acid reflux symptoms that cannot be controlled with medicine or lifestyle changes.
You need tests to diagnose your condition, or procedures to rule out other causes for your symptoms, before you can have this surgery.
A Nissen fundoplication procedure can be reversed 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 acid reflux symptoms.
During Nissen fundoplication surgery, we repair any hiatus hernia. We use permanent stitches to repair the hernia and keep your stomach in place.
Risks of a Nissen fundoplication
All types of surgery have a risk of complications and side effects.
Risks of a Nissen fundoplication include injury to the food pipe, stomach, blood vessels or nearby organs. The surgeon might change the procedure to open surgery (when a cut is made in the skin) to repair any damage. However, these complications are rare.
After the surgery, you might need another procedure if you have:
- problems with swallowing
- bloating (a full and uncomfortable feeling in the stomach) that does not get better
This happens in about 2 in every 100 cases (the complications affect 2% of people).
In some cases, we might need to repeat the surgery if the new valve slips or becomes loose.
If you are being sick (vomiting) or retching (gagging or nearly vomiting) a lot after surgery, there's a risk that:
- you might get a hernia because the stomach moves out of position
- the new valve might move out of position
You might need more surgery to resolve this issue.
It is important to follow our advice about diet after surgery carefully. You also need to take any anti-sickness medicine that we give you to reduce the chance of complications.
Other treatment options
Another option is to keep taking medicines called proton pump inhibitors (PPIs) to manage your symptoms. Before we offer you Nissen fundoplication surgery, we talk to you about these medicines and see if they help you during a trial period.
Medicines called antacids can also help acid reflux symptoms. They neutralise the acid in your stomach.
You can also make changes to your diet and lifestyle to help manage your symptoms. Lifestyle changes include:
- stopping smoking
- doing more exercise
- losing weight
Having smaller, more frequent meals puts less pressure on the valve that connects your food pipe and stomach.
It can also help to have less of some types of food, such as:
- coffee or tea
- fizzy drinks
- citrus fruits (oranges, lemons, limes and grapefruit)
- mint or peppermint
- fatty foods
- spicy foods
- onions and garlic
Giving your permission (consent)
We want to involve you in decisions about your care and treatment. If you decide to have Nissen fundoplication surgery, we ask you to sign a consent form. This says that you agree to have the treatment and 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