Surgery for GERD is referred to as “anti-reflux surgery” and typically involves a procedure called a fundoplication, during which the lower esophageal sphincter is reinforced by wrapping a portion of the stomach around the bottom of the esophagus. Last week we talked about Transoral Incisionless Fundoplication, a partial-fundoplication alternative surgery for reflux. The most common type of fundoplication is the Lap Nissen procedure, and it’s what we’ll be giving you the break-down on today.
The primary issue in patients with GERD is that their esophageal sphincter is either too short or too loose. The Lap Nissen procedure allows surgeons to essentially recreate the sphincter, creating the longest and tightest sphincter possible by taking a portion of the patient’s stomach and wrapping it around the existing sphincter. The awesome thing about the Nissen is that it’s a full fundoplication procedure, so instead of simply creating a 270-300 degree plication like the TIF does, the Nessen allows for a full 360 degree wrap of the stomach around the LES (lower esophageal sphincter). This helps reinforce the sphincter and ensures that food doesn’t splash back up.
The Lap Nissen is one of the oldest and most well-known anti-reflux surgeries out there, and it’s a great option for patients, especially those whose GERD is more severe. The concept is relatively similar to the TIF, the only main differences are the degree to which the plication is performed and the invasiveness of the procedure.
Choosing which anti-reflux surgery is best for you can be difficult, and where these procedures vary the most significantly is in other areas like the pros, cons, recovery details, and cost. Here’s the breakdown for the Lap Nissen:
•It’s one of the most studied anti-reflux surgeries, with over 60 years of data on the durability of the procedure
•90-95% of patients with heartburn will come off their daily heartburn medication post-procedure
•Works well for additional symptoms of GERD other than heartburn, while certain other procedures target only heartburn
•Patients don't need to be weaned off their medications, they simply stop taking them post-surgery
•The Lap Nissen is the most invasive of the anti-reflux procedures. It’s performed laproscopically, so minimal scarring does occur.
•Post-operation bloating can last for monthsDysphasia (difficulty swallowing) can last up to 6-8 weeks after the procedure for some patients
•The procedure reduces vomiting frequency in many patients, which can cause some patients to feel like they've lost the ability to vomit altogether (although if you ask us, this feels like more of a pro)
One of the biggest benefits of the Lap Nissen is that patients can immediately stop taking their daily heartburn medications after the procedure is completed, rather than being weaned off the medications. After the surgery, patients are required to stay overnight in the hospital for observation. You'll be placed on a liquid diet for two weeks following the surgery, a semi-solid diet for weeks 3 and 4, and should be back to a fully unrestricted diet by 8 weeks after the procedure. It is also recommended that patients take two weeks off of work following the procedure.
Coverage for certain anti-reflux procedures can be a little questionable, but that’s not an issue with the Nissen. Although patients may end up fighting for coverage for other procedures like the TIF or the Linx, the Lap Nissen procedure is generally covered in some capacity by all insurances, and typically fully covered by Medicaid. If for any reason there’s a rare scenario in which a patient’s insurance doesn’t cover the Nissen, there are cash pay options available.
Picking the right anti-reflux procedure for you is difficult, which is why it’s important to understand not only how each one works, but also the various pros, cons, recovery details and costs associated with each procedure. The great news for patients with GERD is that you don’t have to make these decisions alone. We’ve got a fabulous group of some of the most knowledgeable doctors in the southeast on staff, and they’re always available to walk you through your options. Contact us to schedule a consult, and be well on your way towards eliminating GERD from your life!