NISSEN FUNDOPLICATION​

 

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Nissen fundoplication is a surgical procedure used to treat gastroesophageal reflux disease (GERD). In this surgery, the upper part of the stomach (the fundus) is wrapped around the lower end of the esophagus. This wrapping creates a new valve mechanism at the bottom of the esophagus, helping to prevent acid reflux, where stomach contents and acid flow back into the esophagus.

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The procedure is named after Rudolf Nissen, the surgeon who first performed it. It's often considered when long-term use of medication isn't effective or desired, and in cases where there are complications of GERD like esophagitis, Barrett's esophagus, or esophageal strictures.

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Nissen fundoplication helps to strengthen and reinforce the GE junction,

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The Nissen fundoplication can be performed laparoscopically, which involves several small incisions in the abdomen, or through a traditional open surgery. The laparoscopic method generally has a quicker recovery time and less post-operative pain.

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                                                      Anesthetic Implications for Nissen Fundoplication

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Anesthesia type: General

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Airway: ETT

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Preoperative:

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• The patient must undergo anatomic and physiologic esophageal evaluation such as esophagogastroduodenoscopy (EGD) and esophageal motility study 

• It is unnecessary to prep the colon for laparoscopic Nissen fundoplication

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Intraoperative:

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• An esophageal dilator (bougie) is lubricated and passed transorally to provide a stent that the surgeon can use to tighten the gastric fundus

• The circumferential fundus creates the fundoplication or “wrap.”

• Position: Modified lithotomy and reverse Trendelenburg

• Duration: 2-3 hours

• EBL: minimal

• Adequate muscle relaxation

• Establishment of pneumoperitoneum

• A nasogastric or orogastric tube is often placed to assist in decompression of the stomach 

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Postoperative:

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• PONV prohylaxis

• Prevention of retching and vomiting

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Complications:

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• Perforation of the stomach or esophagus

• Pneumothorax

• Bleeding

• Gas-bloat syndrome (increase in swallowed air)

• Abdominal distention

• Nausea

• Dysphagia (difficulty swallowing)

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Sources:

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Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed.

 

Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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