Adult Laparoscopic Nissen Fundoplication

WHAT YOU SHOULD KNOW:

A laparoscopic Nissen fundoplication is surgery to treat gastroesophageal reflux disease (GERD). During this surgery, the top part of your stomach is wrapped around the lower part of your esophagus. This prevents stomach acid from moving up into your esophagus.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • Problems may happen during your laparoscopic Nissen fundoplication that may lead to an open surgery. Your esophagus, stomach, liver, bowel, blood vessels, or nerves may get injured during the surgery. This may cause too much bleeding and a large amount of blood loss. You could also have trouble breathing or an infection during or after surgery. The gas used during your surgery may cause shoulder or chest pain for 1 to 2 days after your surgery. Even after you have this surgery, there is a chance that your GERD may come back or become worse. The way the stomach was wrapped to your esophagus may have been too tight or too loose.

  • You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.

  • Laparoscopic Nissen fundoplication offers a shorter stay in the hospital and possible smaller scars. Without treatment, your symptoms of GERD may continue and become worse. The lining of the esophagus may form ulcers and bleed. These may heal into scars that can further narrow the esophagus. If this happens, you may also have sudden severe chest pain and problems swallowing. Ask your caregiver if you have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • Enema: You may need to have an enema before your surgery. This is liquid put into your rectum to help empty your bowel.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

  • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

  • A Foley catheter is a tube put into your bladder to drain urine into a bag. Keep the bag below your waist. This will prevent urine from flowing back into your bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out. Caregivers will remove the catheter as soon as possible to help prevent infection.

  • Gastric tube: This tube is inserted into your nose or mouth and down to your stomach. This keeps air and fluid out of the stomach during surgery. Food or medicine may also be given through this tube.

During your surgery:

  • You may be given medicine to help you relax or make you drowsy. You are taken to the operating room. Your chest and abdomen are cleaned with soap and water. Caregivers may give a general anesthesia to keep you asleep during surgery. An endotracheal (ET) tube connected to a breathing machine may be put into your mouth. This goes down the windpipe to keep your airway open and help you breathe during your surgery. A catheter may be inserted to drain your urine. A gastric tube may also be inserted into your mouth or nose down into your stomach. This tube keeps air and fluid out of the stomach during surgery.

  • During your surgery, a small incision is made above your belly button to insert the laparoscope through. Caregivers insert other instruments by making 2 to 4 smaller incisions at different places on your abdomen. The abdomen is then inflated with a gas (carbon dioxide) to make the abdomen swell. This lifts the abdominal wall away from the internal organs and allows your caregiver more space to work in. The upper portion of your stomach is wrapped around the esophagus. Your caregiver may also repair the muscles of your esophagus if they are weak. The incisions are then closed with stitches or surgical tapes and covered with bandages.

After your surgery:

  • You may be taken to a recovery room until you are fully awake. The ET tube will be removed after you are awake and can breathe well on your own. The catheter that drains your urine and the tube going into your stomach may also be removed. Caregivers will watch you closely for any problems.

  • Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your wound.

  • Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.

  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Medicines: You may be given the following medicines:

    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

    • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.

    • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

      • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

      • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

  • Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.

  • Monitoring: Caregivers may check for pulses on your arms or wrists. This helps caregivers learn if you have problems with blood flow after your surgery. You may also have any of the following:

    • Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

    • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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