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Laparoscopic Nissen fundoplication is a type of keyhole surgery used to treat severe heartburn in cases where medications and lifestyle changes have failed to work. Heartburn is a burning sensation in the chest caused by acid regurgitation from the stomach. It is commonly associated with a condition known as gastroesophageal reflux disease, or GERD, and hiatus hernia, a disorder where the top of the stomach protrudes through the diaphragm. During laparoscopic Nissen fundoplication, part of the stomach is used to enfold the lower part of the esophagus, where it acts as a valve, preventing the back flow of acid. If a hiatus hernia is present, it is repaired during the procedure.
Preparing for a laparoscopic Nissen fundoplication may involve giving up smoking, as smokers are at increased risk of developing an infection after surgery. Stopping smoking is also one of the lifestyle changes which may be beneficial in preventing GERD from progressing to the point where surgery is required. Other helpful lifestyle changes include losing weight, which is probably the most effective change of all, reducing alcohol consumption and eating regular meals.
With laparoscopic surgery, only a short stay in the hospital is usually needed and the Nissen fundoplication procedure may only require one or two nights to be spent in the hospital, with the operation itself taking less than an hour. This is an advantage compared with fundoplication using open surgery, where a large cut is made in the abdomen, requiring a longer recovery time and a possible hospital stay of a couple of weeks. As in open surgery, the laparoscopic operation requires a general anesthetic, so patients are unconscious during the fundoplication procedure.
During the laparoscopic fundoplication operation, small cuts are made in the abdomen and tubes are inserted which then form channels through which instruments can be passed. A laparoscope is a flexible, thin instrument with a camera which allows the surgeon's actions to be viewed on a monitor. The upper portion of the stomach is loosely wrapped around the lower esophagus and sewn in place.
After a laparoscopic Nissen fundoplication, patients may experience pain in the abdomen, which can be treated with painkillers. For a few weeks, there may also be problems with swallowing, due to swelling in the area around the operation site. Complications of a laparoscopic Nissen fundoplication are uncommon, and surgery is usually effective at relieving patients' symptoms. All operations carry risks of blood loss, infection, reactions to anesthetic or blood clots in the legs known as deep vein thrombosis. Occasionally, the valve created during laparoscopic Nissen fundoplication can loosen, so that further surgery becomes necessary.