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Gastroesophageal Reflux (Laparoscopic Nissan Fundoplication)

Also known as GORD, this is a condition that results from the acid in the stomach splashing back up into the oesophagus. When the sensitive lining of the oesophagus is exposed to stomach acid, burning pain (heartburn) may result. Gastroesophageal reflux surgery or anti-reflux surgery corrects this.

The symptoms may include:

  • Heartburn: a burning feeling in the upper abdomen. It can travel through the chest and into the throat and neck. It is believed to be caused by acid irritating the oesophagus.
  • Regurgitation: a warm salty, bitter taste in the mouth. It occurs when stomach contents flow back into the mouth, often when belching. Sometimes food may physically regurgitate to the mouth.
  • Chest pain: pain in the chest reflecting spasm in the oesophagus. It can be caused by the acid returning to the oesophagus and can mimic a heart attack.
  • Hoarseness: this can develop if the acid and/or stomach contents reach the mouth and throat.
  • Choking/Wheezing: may occur at night when stomach contents may enter the lungs.
  • In severe cases of GORD, patients may experience difficulty in swallowing, painful swallowing or bleeding from the oesophagus. The presence of high level of gastric acid in the lower oesophagus may lead to chronic dry cough.
  • Atypical symptoms: Nausea, bad breath, cough and difficulty in swallowing.

The likely causes of these symptoms are:

  • A weak lower oesophageal sphincter that acts as a valve to the stomach. This valve normally remains closed until swallowing forces it open and then closes. With GORD, this sphincter (valve) may be weak and acid splashes back into the oesophagus.
  • Hiatus Hernia: This occurs when part of the stomach bulges up through the diaphragm and into the chest. It has been suggested that a hiatus hernia can prevent the sphincter from working properly. Hiatus hernia is common in the population but not everybody with hiatus hernia will suffer from GORD.
  • Other factors that may contribute to GORD are fatty foods, smoking, chocolate, caffeine, alcohol, obesity and pregnancy.

The first part of the gastroesophageal reflux surgery or anti-reflux surgery operation will entail reducing the herniated stomach and bringing the lower part of the oesophagus into the abdomen. The widened hiatus in the diaphragm, where the oesophagus passes through, will be narrowed to prevent future herniation.

The second part of the gastroesophageal reflux surgery operation is called Nissen 360° Fundoplication. Basically this means creating a new valve, by wrapping the upper part of the stomach around the lower end of the oesophagus, to prevent abnormal reflux. This is the standard operation which can be done via keyhole surgery.

The gastroesophageal reflux surgery procedure is performed under general anaesthetic. A needle is passed through the abdominal wall and gas is introduced to distend the abdomen. At least five small incisions are made to allow the instruments and camera to be passed into the abdominal cavity to perform the operation.

During the operation, the wide opening of the diaphragm is narrowed by stitches (repair of the hiatus hernia), and the lower end of the oesophagus is pulled down and secured in the abdomen by a wrap of the stomach around the lower oesophagus.

There are a small percentage of patients who cannot have the operation performed laparoscopically, due to the huge size of hernia or anatomical difficulties. It may therefore be necessary for the surgeon to convert to the open method. Occasionally it will be advisable not to perform the full wrap and a partial wrap is constructed.

This operation is offered to patients with symptomatic gastroesophageal reflux disease, who have not benefited from non-surgical treatments or are unable to take life-long medications. The aim of this operation is to relieve symptoms and to improve quality of life.

Laparoscopic antireflux is successful in 85-90% of cases. 10-15% of cases will have recurrent symptoms within 10 years after the operation. It is unlikely for recurrent symptoms to appear after 10 years.

Sometimes, especially with large hiatus hernia, reflux symptoms may improve dramatically, but do not disappear completely and the patient may require occasional medication.


The Sefton Suite
Liverpool University Hospitals NHS Foundation Trust
Lower Lane
L9 7AL
Telephone: 0151 257 6700