A Patient’s Story
James, a 46-year-old finance director, had lived with severe acid reflux for years. Despite strict dietary changes and long-term medication, his symptoms persisted. Night-time regurgitation disrupted his sleep, and ongoing chest discomfort began affecting both his work and quality of life.
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After specialist testing confirmed ongoing reflux and a weakened lower oesophageal sphincter, James was referred for Nissen fundoplication as a definitive treatment option.
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For patients like James, surgery can provide durable symptom control when medical therapy is no longer effective.
What Is Nissen Fundoplication?
Nissen fundoplication is a surgical procedure used to treat gastro-oesophageal reflux disease (GERD). It is named after Dr Rudolf Nissen, who developed the technique to strengthen the natural barrier between the stomach and oesophagus.
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The primary aim of the procedure is to prevent stomach acid and contents from refluxing into the oesophagus, thereby reducing symptoms such as heartburn, regurgitation, and reflux-related chest pain.
How the Procedure Works
During Nissen fundoplication, the upper part of the stomach is wrapped around the lower end of the oesophagus, forming a secure, circular valve. This wrap reinforces the lower oesophageal sphincter (LES), making it more resistant to reflux while still allowing food to pass normally into the stomach.
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The operation is most commonly performed using keyhole (laparoscopic) surgery, which typically results in smaller incisions, faster recovery, and reduced post-operative discomfort.
Types of Fundoplication
There are different surgical approaches, chosen based on individual anatomy and oesophageal function:
Full (360-degree) fundoplication
The stomach is wrapped completely around the oesophagus, offering strong and reliable reflux controlPartial fundoplication
The wrap covers only part of the oesophagus, either anteriorly or posteriorly, and may be preferred in patients with reduced swallowing strength to lower the risk of post-operative difficulty
Who Is a Suitable Candidate?
Nissen fundoplication may be considered if you have:
Persistent GERD symptoms despite optimal medication
Objective evidence of reflux on diagnostic testing
Complications such as oesophagitis or reflux-related lung symptoms
A desire to avoid lifelong acid-suppressing medication
Careful patient selection is essential to achieving good surgical outcomes.
Preoperative Assessment
Before surgery, patients undergo comprehensive investigations, which may include:
Endoscopy
Oesophageal manometry to assess swallowing function
pH or impedance testing to confirm acid reflux
Imaging studies where clinically indicated
These tests ensure that surgery is appropriate, safe, and tailored to the individual patient.
Risks and Recovery
Nissen fundoplication is generally safe and well established, but potential risks include:
Temporary swallowing difficulty
Gas bloating or difficulty belching
Changes in eating patterns during early recovery
Post-operative care focuses on gradual dietary progression, starting with soft foods and advancing slowly. Smaller, more frequent meals are advised while healing occurs.