This surgery is done to help prevent gastro-esophageal reflux (heartburn).  This works by creating a high pressure zone at the end of the esophagus so stomach contents can't go back up.  A part of the stomach is wrapped around the esophagus and stitched to itself.  This is done while a large tube is in the esophagus so that the wrap can't be made too tight.

If you have a hiatal hernia, this can usually be corrected at the time of this surgery.  Prior to surgery, you will likely have manometry performed.  This is a test to assure normal esophagus function -- if a wrap is performed on an esophagus that doesn't work right, you'll likely feel worse.  This test is performed by placing a small tube through the nose into the esophagus, this tube measures pressures in the esophagus while you swallow.  Most people tolerate this test well; it takes about a half-hour and is performed in Endoscopy at HealthPark (our office building).

The surgery is done laparoscopically (small holes), but may require a larger incision in rare cases.  Most patients spend one night in the hospital and go home the next day.  Patients must consume a full-liquid diet for two weeks after surgery (while swelling is going down), then switch to a soft diet for two weeks.  At that time, most patients are able to resume a routine post-Nissen diet.  This means limiting bites to toddler-sized portions, eating more slowly and limiting common problem foods such as breads, whole meats (steak), and certain fibrous vegetables.  A dietician will review this restrictions with you while in the hospital.  Most people find that that the elimination of painful reflux from their lives is well worth restricting their diets.  After surgery, the vast majority of patients do not require antacid medication again.

Things to know about this surgery:

• Eat a LOW FAT DIET before surgery.  This helps clear fat from the liver making it more easily moved. The surgery happens under a part of the liver and thus this part of the liver needs to be held out of the way during surgery.  If the liver is more easily moved, we can see better and thereby increase the likelihood that we can complete the surgery laparoscopically.
• Most people take a week, sometimes two weeks off from work.  Most people take narcotic pain pills for 3-5 days after surgery.  You cannot drive while taking narcotics and you shouldn't be working or caring for children or other adults.
• You will need to limit your lifting to less than 20 pounds for at least two weeks after your surgery, maybe longer if you do very strenuous work.  This will help limit your risk of a hernia at the incision sites.
• The most common risk is infection, this happens very rarely.  Bleeding is also a possibility, but again is quite rare.
   

The most important thing to remember is that people do well with this surgery and feel better because of it.  There are always risks to any surgery, but they are very rare with this surgery.