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Adult Laparoscopic Nissen Fundoplication
WHAT YOU NEED TO 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.
HOW TO PREPARE:
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 healthcare provider for more information about these tests. 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. Healthcare providers may give you a liquid medicine called an enema. This will be put into your rectum to help empty your bowel. Your healthcare provider 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.
- 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.
- What to bring: You may want to bring items such as a toothbrush and bathrobe.
- 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.
WHAT WILL HAPPEN:
What will happen:
- You may be given medicine to help you relax or make you drowsy. You will be taken to the operating room. Your chest and abdominal area will be cleaned with soap and water. Healthcare providers 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 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, a small incision will be made above your belly button to insert the laparoscope through. Healthcare providers will insert other instruments by making 2 to 4 smaller incisions at different places on your abdomen. The abdomen will then be inflated with a gas (carbon dioxide) to make the abdomen swell. This lifts the abdominal wall away from the internal organs and allows your healthcare provider more space to work in. The upper portion of your stomach will be wrapped around the esophagus. This will make a valve (door) that closes better between the esophagus and stomach. Your healthcare provider 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 urine catheter and tube going into your stomach may also be removed. Healthcare providers will watch you closely for any problems.
- Do not get out of bed until your healthcare provider says it is OK. When healthcare providers 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 healthcare provider may remove the bandages soon after your surgery to check your wound.
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 YOUR HEALTHCARE PROVIDER 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.
- 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 healthcare provider if you have questions about your surgery, medicine, or care.
Care AgreementYou 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.
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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.