Adult Open Nissen Fundoplication

WHAT YOU SHOULD KNOW:

• An open Nissen fundoplication (fun-do-pli-KA-shun) is surgery to treat gastroesophageal reflux disease (GERD). GERD occurs when the lower muscle of the esophagus, called the lower esophageal sphincter, does not close properly. The esophagus is the tube that carries food and liquid from the throat to the stomach. GERD causes the stomach acid and food in the stomach reflux (back up) into the esophagus. When the acid irritates and damages the esophagus, it may cause a burning feeling called heartburn.
  
  
• With an open Nissen fundoplication, an incision (cut) is made in your abdomen to show your lower esophagus and stomach. During this surgery, your caregiver wraps the upper portion of the stomach around the esophagus. This is done to put pressure on the lower esophageal sphincter and prevent reflux. With an open Nissen fundoplication, the symptoms of GERD may be relieved and damage to your esophagus prevented.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• Problems may happen during your open Nissen fundoplication that may lead to more surgeries. Your esophagus, stomach, liver, bowel, blood vessels, or nerves may get injured while having 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. Even after having this surgery, there remains 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.
  
  
• Without an open Nissen fundoplication, 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 narrow the esophagus. If this happens, you may also have sudden severe chest pain and problems swallowing. Not having this surgery may also cause changes in the lining of the esophagus and lead to other medical problems. Ask your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Enema: You may need to have an enema the morning before your surgery. This is liquid put into your rectum to help empty your bowel. Caregivers will teach you how to do this.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• 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: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
  
  
• Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag. The bladder is an organ where urine is kept. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink because this will block the flow of urine.
  
  
• 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. You may also need it if you throw up a lot after 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 on a stretcher to the operating room and then moved onto a special bed. Your chest and abdomen (stomach) 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, an incision is made on the center part of your upper abdomen. This incision may reach your umbilicus (belly button). Another incision may also be made on the left side of your chest between two ribs. Your caregiver wraps and stitches the upper portion of your stomach around the esophagus. Your caregiver may also repair the muscles of your esophagus if they are weak. The incisions are then closed with stitches (threads) 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 may 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. Ask your caregiver for more information about ways to prevent bleeding and take care of your incision.
  
  
• Activity: Caregivers may help you get out of bed to walk on the same day of surgery, or the day after. Ask caregivers if there are exercises that you may do while in bed. Exercise helps blood move through your body and may help prevent blood clots from forming. Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy while standing up, sit or lie down right away and call your caregiver.
  
  
• Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.
  
  
• Medicines: Your caregiver may give you the following kinds of medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
  
  
• 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: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.
    
    
  • Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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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