Laparoscopic Nissen Fundoplication

General Surgery
Laparoscopic Nissen
Fundoplication
patientinformation
Rotherham HospitalYour health,your choice,our passion
Laparoscopic Nissen Fundoplication
Laparoscopic Anti-reflux surgery
This is a surgical method, which can treat severe
gastro-oesophageal reflux. It is an alternative to
long-term suppression of acid secretion by the
stomach using drugs and to open surgery.
What is a Laparoscopic Nissen Fundoplication?
Laparoscopic (keyhole) Nissen Fundoplication is an
operation to relieve chronic heartburn when it cannot
be controlled with medication and/or lifestyle changes.
Heartburn is an uncomfortable burning feeling that
usually starts in the middle of your chest, behind your
breastbone, and moves upwards towards your neck
and throat. Heartburn is usually caused when the
contents of the stomach is pushed back into the gullet
(oesophagus), causing irritation of its sensitive lining.
The causes may include:
l Gastro intestinal reflux disease (when acid from
the stomach flows back up into the oesophagus).
l Hiatus hernia (when part of the stomach slides
into your chest cavity).
l Certain foods, smoking and alcohol may make
the symptoms of heartburn worse.
Surgery can relieve your symptoms of heartburn.
However, in a small number of cases the symptoms
can come back. Please discuss any concerns you may
have with your surgeon.
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Laparoscopic Nissen Fundoplication
What are the benefits of keyhole surgery?
If the operation is done laparoscopically “keyhole”
then you are likely to recover quicker than if it was
done using the open method. You will have less
scaring and suffer less pain.
What happens before the operation?
The pre-assessment nurses will see you before you
come into hospital for your operation. Various checks
will be carried out to ensure you are fit for the operation
to go ahead. The operation will be explained to you
and the nurses will give you instructions about fasting
and about whether you need to stop taking any of your
usual medicines. If you have any questions or concerns,
this is the time to talk to the doctor or nurse.
Arriving at hospital
On the day of your operation you will be asked to report
to the Theatre Admissions Unit. Further information will
be given to you at your pre-operative assessment visit,
along with a leaflet about what happens in Theatre
Admissions Unit before your operation.
What happens before the operation?
You will be seen by the surgeon who will be doing
the operation. The operation will be explained to you
and you will be asked to sign your consent form for the
operation, if you have not done so already. If you are
not clear about any part of the operation, please ask
for more details.
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Laparoscopic Nissen Fundoplication
You will also be seen by the anaesthetist to check your
health and to discuss your anaesthesia. You will have
a general anaesthetic, this means you will be asleep
throughout the operation. More details about the
anaesthetic will be given to you at your pre-operative
assessment visit and by the anaesthetist.
What does ‘fundoplication’ involve?
Laparoscopic or ‘keyhole’ surgery involves making
4 to 5 small incisions in your abdomen through which
special surgical instruments are passed into the body.
A harmless gas is used to inflate your abdomen
to make space for the operation to be performed.
This will disperse naturally after the operation.
What are the benefits of heyhole surgery?
If the operation is done laparoscopically “keyhole”
then you are likely to recover quicker than if it was done
using the open method which would involve a 6 to 10
centimetre cut on your abdomen. You are able to recover
more quickly from the operation, have less scaring and
suffer less pain.
How is the operation done?
The surgeon will wrap the top part of your stomach
around the lower part of your gullet to form a collar.
This tightens the closing mechanism at the lower end
of the gullet, creating a one-way valve, which prevents
stomach acid from moving back into your gullet.
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Laparoscopic Nissen Fundoplication
Hiatus hernia
Where there is a hiatus hernia, the surgeon will bring
the stomach back into its original position under the
diaphragm, then wrap the upper few centimetres of
the stomach around the oesophagus to make a new
valve. This prevents acid reflux and heartburn recurring.
Permanent stitches are used to keep the stomach
in place.
Open method
In a small number of patients the laparoscopic method
cannot be performed.
The decision to perform an open procedure is a decision
made by your surgeon either before, or during the actual
operation. If the surgeon decides to convert a laparoscopic
procedure to an open one, this is not a complication
but sound surgical judgment and is strictly based on
patient safety.
Stitches
You will have stitches that will be either dissolvable
or that will need removing in 7 to 10 days. The nurse
looking after you will give you further instructions
before your discharge.
How long will I stay in hospital?
You will normally stay in hospital for two or three days.
This may be longer if the open procedure is used.
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Laparoscopic Nissen Fundoplication
On the ward after the operation
You will wake up from your general anaesthetic in the
recovery area. The recovery nurse will check your blood
pressure and wound sites. As soon as you are fully
awake, comfortable and your blood pressure is stable,
you will be taken to the ward.
On the ward the nurses will monitor your progress and will
give you pain relief. You will be encouraged to get up as
soon as possible and start with a liquid diet. You may have
anything except fizzy drinks. You will stay in hospital for
2 to 3 days and in this time your pain will be monitored
and you will be encouraged to eat a blended diet.
After the operation/going home
You will be seen by the nurse specialist and the dietitians
before you are discharged home. The dietitians will give
you some suggestions for foods you can eat.
Signs to look out for
You should call your doctor if you develop any
of the following symptoms:
l A fever
l An unusual degree of pain
l Nausea and vomiting and can not eat
properly according to your diet plan
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Laparoscopic Nissen Fundoplication
What are the possible risks?
All operations carry the risk of problems and side effects.
Complications are unexpected problems that can occur
during or after the procedure. Most people are not
affected. Specific risks connected to this procedure are:
l Injury to the gullet, stomach, blood vessels and
nearby organs. These complications are rare and
the surgeon may convert to open surgery
to repair any damage.
l 1% of patients (1 in 100) may need further corrective
surgery to reduce persistent difficulty in swallowing
and /or abdominal bloating.
l A hernia may develop in one of the wound sites
(where a part of the bowel sticks out through
the weak area of the abdomen), which may need
repairing. This may happen if you put any strain
through that area while it is healing.
Common side effects
l The most common side effect is difficulty in swallowing. This is common immediately after
the operation and gradually improves. The amount
of food you consume may be less and you may
have to eat more slowly than you did before
the operation. You will need to adhere to the
recommended diet of blended then soft diet
for 4 to 6 weeks.
l Other common side effects are burping,
bloating and increased wind (flatus).
l Most of these symptoms settle with time.
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Laparoscopic Nissen Fundoplication
Driving
You may drive again when you can confidently perform
an emergency stop. This is usually about 10 days after
your operation. You may also wish to check with your
insurance company about when you are covered
to drive again.
Returning to work and resuming normal
activities
You will need 3 to 6 weeks off depending on the
nature of your work. You can resume lifting and
strenuous exercise after 6 weeks.
Follow-up
On discharge from hospital you will be given an
appointment to see your surgeon in the Outpatient
Department 6 weeks after your operation.
Nutrition guidelines after Laparoscopic
Nissen Fundoplication
Do I need a special diet?
Following a special diet after surgery is necessary for
healing. After the procedure, your diet will progress
in stages beginning with liquids and slowly advancing
to a soft diet. We have recommended time periods for
each stage as a guideline, however please be aware
that everyone’s tolerance to food may be different.
The dietitian will visit you on the ward to talk to you
about these different stages and answer any questions
you may have.
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Laparoscopic Nissen Fundoplication
General Guidelines
l Eat small frequent meals (6 to 8 per day) to ensure
adequate nutrient intake and to prevent feeling
too full.
l Sit upright while eating and remain upright for
20 minutes after eating.
l To help minimize burping, avoid drinking fizzy drinks,
chewing gum or drinking through a straw.
l Once on solids, chew food well and eat slowly.
l Keep foods moist by adding sauces or gravy.
Stage 1 - Liquid diet
This diet will begin while you are in hospital and
may last for up to 3 days after surgery. Examples
of liquids you can consume at this time include:
l milk
l soup
l jelly
l ice-cream
l hot chocolate
l malted drinks e.g. ovaltine, horlicks
l more nourishing drinks such as build-up shakes
or soups which can be provided on the ward
Stage 2 - Pureed diet
The next stage introduces food in a smooth pureed
texture, to allow easier swallowing. It is recommended
that you follow this stage for 3 to 4 weeks. A food
processor or blender will be needed to puree foods to
the correct consistency and a basic one can be
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Laparoscopic Nissen Fundoplication
purchased quite cheaply. You may need to add liquid
in order to puree some foods, however try to avoid
adding water as this dilutes the amount of nutrients.
Instead, try stock, gravy, cream, sauce or soup. Please
refer to the table on page 14 for food and drink
suggestions. Your dietitian will also provide you with
a diet sheet entitled ‘Eat well to feel better on a
pureed diet’ for further meal ideas, tips on preparing
pureed foods and ways to make it look presentable.
Stage 3 - Soft diet
If you feel no pain or discomfort on the pureed diet at
the end of Stage 2, proceed to a soft diet, avoiding any
large solid lumps. If you try to eat foods which have
to be swallowed in one lump (like chicken or steak)
there is a risk they will get stuck, which can be very
uncomfortable. Also remember to chew food well. It
is recommended that you follow this stage for 2 to 3
weeks. Please refer to the table on the following page
for food and drink suggestions. Your dietitian will also
provide you with a diet sheet entitled ‘Eat well to feel
better on a soft diet’ for further meal ideas and tips
on how to make foods softer.
Stage 4 - Normal diet
At the end of Stage 3 you can slowly introduce
a normal healthy diet as tolerated.
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Laparoscopic Nissen Fundoplication
Food Group
(3 to 4 weeks)
Pureed Diet
(2 to 3 weeks)
Soft Diet
Bread, Other Cereals
& Potatoes
Porridge mixed to a smooth consistency.
Breakfast cereals
softened with milk to
a smooth consistency.
Pasta pureed with sauce.
Mashed potatoes. Pasta, rice, potato added to soup
and pureed.
Porridge.
Breakfast cereals
softened with milk.
Pasta or rice with sauce.
Mashed potatoes.
Jacket potatoes without skin.
Bread softened with spread.
Fruit & Vegetables
Fruit juice.
Pureed tinned, stewed or soft fresh fruits e.g. peaches, berries, bananas.
Pureed vegetables with
your favourite sauces.
Fruit juice.
Tinned, stewed
or soft fresh fruits. Mashed or soft cooked vegetables.
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Laparoscopic Nissen Fundoplication
Food Group
(3 to 4 weeks)
Pureed Diet
(2 to 3 weeks)
Meat, Fish & Pureed meat, fish, Alternatives
poultry, pulses with
gravy/sauce and sauce.
Pureed scrambled egg (try mixing in cheese
or pureed tomatoes).
Milk & Dairy
Soft Diet
Flaked fish. Minced beef, chicken
or turkey and gravy.
Omelette, scrambled
poached or boiled egg.
Baked beans.
Well cooked lentils.
Milk.
Milk.
Smooth yogurt Yogurt.
(without chunks of
Cheese.
fruit, muesli or nuts).
Milk puddings.
Cheese spread/soft cheese.
Milk based desserts,
custard, pureed
rice pudding/semolina,
ice cream.
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Laparoscopic Nissen Fundoplication
Further information
If you have any further questions
or concerns about the information
in this booklet, please contact:
Pre operative Assessment Unit
01709 427943
Mr Lambertz secretary
01709 427165
Upper GI Nurse Specialist
01709 424077
Nutrition and Dietetics
01709 424297
Useful contact numbers
NHS Direct Telephone 0845 4647
Patient Services
Telephone 01709 424461
Health Info Telephone 01709 427190
Stop Smoking Service Telephone 01709 422444
A&E
Telephone 01709 424455
For GP out of hours,
contact your surgery
Useful websites
www.nhs.uk
www.direct.gov.uk
www.therotherhamft.nhs.uk
If you require this document in
another language, large print,
braille or audio version, please
contact Patient Information on
01709 424281.
Produced by Chris Garrison, Mr Lambertz
and Nutrition and Dietetics, July 2010.
Revised November 2011.
Revision due November 2013, Version:2.0
©The Rotherham NHS Foundation Trust 2011.
All rights reserved.
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Mr Lambertz Secretary
Telephone 01709 427165
Upper GI Nurse Specialist
Telephone 01709 424077
Nutrition and Dietetics
Telephone 01709 424297
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