Dr. Leonardo Espinel
(615) 223-1293
Laparoscopic Nissen Fundoplication
Information Sheet
What is Gastroesophageal Reflux Disease?
Gastroesophageal Reflux Disease (GERD) is caused by gastric acid flowing from the stomach
back into the esophagus. This occurs when the lower esophageal sphincter (LES) malfunctions
allowing stomach acid and partially digested food to reverse its movement. GERD frequently
causes heartburn, and left untreated, may cause ulcers and bleeding in the esophagus.
Untreated, severe reflux can also lead to cancer of the esophagus. Hiatal hernias are
sometimes associated with GERD. A hiatal hernia occurs when part of the stomach protrudes
through the diaphragm. This causes the LES to become weak and malfunction.
How is a Laparoscopic Fundoplication performed?
In a Fundoplication, the upper part of the stomach is wrapped around the lower esophagus and
stitched into place. This strengthens the LES and prevents gastric acid from entering the
esophagus. If a hiatal hernia is present, this is also corrected during surgery. Four or five little
“puncture” wounds are made in your abdomen and then tiny tube shaped instruments are
passed into these incisions. The laparoscope is connected to a high intensity light and a video
camera so that the surgeon can see what is happening inside of you. The surgeon then uses
several more tiny tubes with miniature instruments to carry out the procedure. To provide
space for the surgery to be performed, your abdomen is filled with a harmless gas.
Are there any side effects of this operation? (Yes, but these are temporary)
One of the most common side effects of this operation is difficulty in swallowing. This is most
pronounced immediately after surgery and gradually improves. You may also notice a
reduction in the amount of food that can be taken and having to eat more slowly than before.
Other common side effects of this operation are intermittent bloating of the stomach and
increased wind (flatus). This occurs because the new one-way valve between the stomach and
the esophagus does not allow air to be freely belched out. It will therefore pass through the
intestine leading to increased flatus from the back passage. Most of these symptoms tend to
settle down with time.
Pain management after surgery:
Most pain can be associated with the “gas” that is used to inflate the abdomen during surgery.
The best way to get rid of this is to walk and to use the incentive spirometer given to you upon
hospital discharge (see below). It is common for this gas to cause shoulder pain as it works its
way out of your body. This discomfort will gradually disappear over several days. Again,
walking is the best way to get rid of this gas.
It is also normal to have incisional pain after surgery. This should start to subside after a few
days. To minimize discomfort, you can take painkillers regularly over the first few days. Taking
a stool softener along with pain medication can help to avoid constipation. If you have not had
a bowel movement two days after your surgery, drink a bottle of magnesium citrate every six
hours until you have a bowel movement. Call your doctor if you have consumed three bottles
over an eighteen hour period without having a bowel movement. Magnesium citrate is a liquid
laxative sold over the counter in any pharmacy. You may want to purchase three bottles before
your surgery in case you cannot have a bowel movement.
Taking care of your incisions:
If you have bandages over the incisions, remove them two days after surgery. If you do not
have bandages, your incisions were closed with skin glue. Either way, you should not get the
incisions wet for 48 hours. After two days, keep your incisions clean with plain soap and water
in the shower. It is not necessary to apply more bandages. The incisions may be red and
uncomfortable for 1-2 weeks as some bruising and swelling is common. Avoid tight clothing
and fabrics which may irritate the skin around the incision sites. Some drainage from the
incision sites is okay. Please call us if it becomes thick in consistency or is greenish in color.
Incentive spirometer:
This breathing device for exercise will be given to you before you leave the hospital. Use it as
you were instructed by the nurse in the hospital. Along with walking, it helps to prevent the
collapse of the lungs and pneumonia after surgery while helping alleviate surgical gas-related
shoulder pain.
What activities can I do after my surgery?
Avoid heavy lifting and strenuous activities for at least two weeks. You can return to normal
physical and sexual activities when you feel comfortable. You can return to work as soon as
you feel well enough. This will depend on your individual healing process and the type of work
that you do. Typically you will need two to three weeks off work. You should not drive for at
least 2-3 days after surgery, or longer if still taking narcotic pain medicine.
Post Operative Diet
After surgery, normal post operative swelling will prevent you from eating a regular diet.
Therefore, you must adhere to a liquid or pureed diet for the first week and then slowly
transition back to traditional food choices as the swelling resolves. This will help prevent chest
pain, choking on food, and yield a smoother recovery.
General Guidelines:
Eat 4-6 smaller meals each day – eat every 2-4 hours. Start by eating about 1 cup per meal.
Choose soft, moist foods that are easier to chew and to swallow. See attached chart for ideas.
Take smaller bites and be sure to chew your food thoroughly. You should be chewing your food
to a baby food consistency. If needed, use a blender to puree foods to a more easily tolerated
consistency.
Avoid cold liquids and food for the first 2-3 weeks as they may cause painful esophageal spasm
or irritation.
To minimize the amount of air that you swallow, avoid gulping food or drinks, do not chew gum
or tobacco, and avoid drinking with a straw. Also, do not smoke or drink caffeine. Finally, you
should avoid carbonated beverages.
Sit upright while eating or drinking. Remain in an upright position for 30 minutes after eating.
Do not recline.
Stage 1: Liquid/Pureed Diet (First week)
Clear liquids include water, jello, broth, crystal light, popsicles, lemonade, apple juice, cranberry
juice, grape juice, decaffeinated tea or coffee (without cream). Avoid caffeinated beverages,
carbonated drinks, gum, alcohol, and hard candy.
Foods that you can puree in a blender include fruit without pulp or seeds, pasta, mashed
potatoes, vegetables, soups, moist meat with no bones, and oatmeal. Applesauce, baby food,
smooth puddings and custard, yogurt, milkshakes, Ensure, and Boost are also acceptable.
Stage 2: Soft Diet (Weeks 2-4)
Soft foods include finely chopped meat with gravy (no bones), soft cooked scrambled eggs, hot
cereals, cold cereals softened with milk, soft cheeses, cottage cheese, cut up pasta, mashed
potatoes, soft cooked chopped vegetables, soft canned fruit (no pineapple), and bananas.
Do not eat raw vegetables, steak, chips, tacos, bread, waffles, biscuits, crackers, sandwiches or
hamburgers.
Stage 3: Transition To Regular Diet (Weeks 4-6)
You can begin to eat a regular diet again. Foods that you can add to your diet as tolerated
include bread, rolls, muffins, granola, shredded wheat, pancakes, waffles, rice, raw vegetables,
corn, coleslaw, salads, baked potato with skin, fruit with seeds, nuts, peanut butter, raisins,
dates, hard fruit with skin, dried or candied fruit, unchopped meat, dry meat, fish with bones,
yogurt with fruit or nuts, un-grated hard cheeses, coconut, popcorn, pickles, carbonated drinks,
caffeinated drinks, chips, and alcohol.
Remember to chew your foods thoroughly, take small bites, and eat slowly.