Adult Open Nissen Fundoplication

What you should know

An open 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 helps prevent 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 open Nissen fundoplication that lead to more surgeries. 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 may get an wound infection or a blood clot in your leg or arm after surgery. A blood clot 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. Even after you have this surgery, there is a chance that your GERD may come back or become worse.

  • Without an open Nissen fundoplication, your symptoms 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. There may be changes in the lining of the esophagus that lead to other medical problems. Ask your caregiver if you 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 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 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 will talk to you before your surgery. You may need medicine to keep you asleep or numb an area of your body during surgery. Tell caregivers if you or anyone in your family has had a problem with anesthesia in the past.

  • You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are 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 to the operating room. Your chest and abdominal areas are cleaned with soap and water. Caregivers will 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 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 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 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.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

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.

Seek Care Immediately if

  • You have sudden severe chest pain.

  • You have trouble swallowing or breathing.

  • Your signs and symptoms are becoming worse.

© 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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