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.

GETTING READY:

The week before your surgery:

• Ask a family member or friend to drive you home after surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• You may need to have a barium swallow, esophageal pH monitoring, manometry, endoscopy, or upper gastrointestinal (GI) series. You may also need a 12-lead echocardiography (ECG), chest x-ray, or blood tests. Ask your caregiver for more information about these tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  
• Your bowel may need to be emptied and cleaned out before the surgery. Caregivers may give you a liquid medicine called an enema. This will be put into your rectum to help empty your bowel. Your caregiver will teach you how to do this.
  
  
• You may be given medicine to help you sleep.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• Bowel preparation:
  
  
  • Do not eat or drink anything on the morning of your surgery. Your stomach and bowel need to be totally empty during your surgery. If you need to take medicines, you may have them the morning of your surgery with a few small sips of water.
    
    
  • You may need an additional enema, using warm water, the morning of your surgery.
  
  
• Do not wear tight-fitting clothes on the day of your procedure or surgery.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

TREATMENT:

What will happen:

• 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 abdominal (stomach) areas are cleaned with soap and water. Caregivers may give you 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 will go 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 will be 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 will wrap and stitch the upper portion of your stomach around the esophagus. This will make a valve (door) that closes better between the esophagus and stomach to prevent reflux. 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.

Waiting room: This is a room where your family and friends can wait until you are ready for visitors. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

CONTACT A CAREGIVER IF:

• You cannot make it to your appointment on time.
  
  
• You have questions or concerns about your surgery.
  
  
• You have a fever (increased body temperature).

SEEK CARE IMMEDIATELY IF:

• You have sudden severe chest pain.
  
  
• You have trouble swallowing or breathing.
  
  
• Your signs and symptoms are becoming worse.

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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