NISSEN FUNDOPLICATION SURGERY helps prevent reflux by supporting the lower esophagus with the upper stomach. It is a surgical procedure designed to prevent acid reflux by reinforcing a weak lower esophageal sphincter with the patient’s stomach tissue. During the procedure the upper portion of the stomach is completely wrapped around the bottom of the lower esophagus and then stitched into place to create a strong barrier that prevents stomach acid from backing up into the esophagus.

NISSEN FUNDOPLICATION SURGERY CAN BE COMPLETED THROUGH:

OPEN SURGERY, which is done through a long incision in your abdomen. Patients typically spend a few days in the hospital following surgery, and can return to work within 4-6 weeks.

LAPAROSCOPIC SURGERY, which requires 5 small abdominal incisions. Patients typically go home and can return to relative normal activity within 7-10 days.

PROS:

CONS:

The Nissen fundoplication changes the patient’s anatomy to prevent reflux
Post-operation bloating can last for months
Dysphasia (difficulty swallowing) can last up to 6-8 weeks after the procedure for some patients
Lowers vomiting frequency, causing some patients to feel like they’ve lost the ability to vomit

THE LINX® SYSTEM AUGMENTS THE WEAK LOWER ESOPHAGEAL SPHINCTER TO HELP PREVENT REFLUX

The LINX® System is a small, flexible band of magnets enclosed in titanium beads. The beads are connected by titanium wires. The magnetic attraction between the beads helps keep the weak LES closed to prevent reflux. Swallowing forces temporarily break the magnetic bond, allowing food and liquid to pass into the stomach. Magnetic attraction closes the LES after swallowing, to reinforce the body’s natural barrier to reflux.

HOW IS THE LINX® SYSTEM IMPLANTED?

The LINX® System is placed around the esophagus just above the stomach using a common, minimally invasive, surgical technique called laparoscopy. Patients are placed under general anesthesia during the procedure, which is generally completed in less than one hour. Once implanted, the device will begin working immediately.

PROS:

Outpatient procedure, patients go home the same day
90-92% of patients are off their medications immediately
Ability to burp and vomit are preserved identical to whatever they were pre-operatively
Can be converted to NISSEN Fundoplication down the line if necessary
Same effectiveness of NISSEN Fundoplication without the side effects

CONS:

LINX has only been around for 13 years, so there is the least research and data to support the effectiveness of the procedure than with other surgeries
Takes the longest period of time to get insurance coverage authorization (typically only an 80% success rate)

RECOVERY:

Unlike other surgeries, patients may go straight home after undergoing the LINX procedure. There is no overnight stay required. The patient is required to eat something small every three hours while they’re awake for at least 6 weeks after the procedure. Patients can come straight off their daily medications. Doctors recommend that patients can return to work in 7-10 days after undergoing the LINX procedure.

WHAT IS A HIATAL HERNIA?

Hiatal hernias occur when part of the upper stomach enters the chest through the hiatus, an opening in the diaphragm that the esophagus passes through. This is usually due to a combination of pressure and a weakness of muscle or fascia. There are two different types of hiatal hernias: sliding and paraesophageal. A sliding hernia occurs when the stomach and the part of the esophagus that joins the stomach slide up into the chest through the hiatus. In a paraesophageal hernia, the esophagus and stomach both stay in their normal place, but a small section of the stomach enters the chest through the hiatus and ends up next to the esophagus. Paraesophageal hernias are the less common of the two, and in many cases may be more dangerous.

Hiatal hernias are common in patients with GERD, with up to 90% of GERD patients having one. Hiatal hernias are oftentimes discovered when patients come in complaining of GERD symptoms.

DIAGNOSING A HIATAL HERNIA:

Hiatal hernias are typically diagnosed by:
X-rays
Upper endoscopy examinations

SYMPTOMS OF A HIATAL HERNIA:

Many smaller hernias (less than 2.5 inches in size) cause no symptoms, so it’s not uncommon for a hiatal hernia patient to be unaware they have one. On the other hand, very large hernias can cause upper abdominal or chest pain, and may require surgical repair to prevent strangulation of the stomach.

TREATMENT FOR HIATAL HERNIAS:

Because there are no symptoms caused by hiatal hernias, they are often left untreated if they occur in conjunction with no other conditions. In severe paraesophageal hernia cases the stomach can become strangled. In cases like these, surgery may be necessary to reduce the hernia. These surgeries usually consist of three parts:

Freeing up the attachments that are keeping the stomach up in the chest in order to get the stomach back down into the abdomen.

Repairing the opening in the diaphragm with sutures and an onlay patch to reinforce the sutured closure.

Folding the stomach around the lower esophagus to create a wrap which helps prevent the stomach from riding back up into the chest.

In cases where hiatal hernias are coupled with GERD, treatment for the hernia typically consists of repairing the hiatal hernia and treating the patient’s GERD to minimize or eliminate their reflux. There are many different treatment options for GERD, from simple changes in lifestyle and diet to medication or, in many cases, anti-reflux/GERD surgery.