Contraindications for Nissen Fundoplication Surgery

Rick from Houston Sent us this question: “Hello, I just got my results back from esophageal manometry test and my acid reflux specialist said I have almost no motility. He said it’s like being gravity fed into my stomach. He also told me that I was not a candidate for a fundoplication surgery. I have mild esophagitis and cannot seem to get rid of it, I am burning up every day. Is there anything that can be done?

Dear Rick,

Thank you for submitting this interesting question to Houston Heartburn and Reflux Center. Proper work up and diagnosis prior to Nissen fundoplication surgery is crucial to any heartburn surgery success. Manometry is one of the tests we routinely perform at Houston Heartburn and Reflux Center prior to Nissen fundoplication surgery. The purpose of this test is first to rule out esophageal motility disorders like achalasia that require a different surgical treatment than GERD. Achalasia is a rare esophageal motility disorder characterized by lack of esophageal peristalsis. Patient may present with constant heartburn mimicking acid reflux disease. The treatment for achalasia is different from that of GERD and Nissen fundoplication is contraindicated in the setting of achalasia. Second, manometry measures esophageal contractions and help us differentiate between normal and weak or ineffective motility. Patients with very weak motility, you’re your case most likely, present a relative contraindication for Nissen or 360-degree fundoplication and are better served with partial or Toupet fundoplication. Partial fundoplication is believed to be associated with a lower post-operative dysphagia rate. I personally prefer to offer a loose two stitch Nissen fundoplication in cases of weak motility. I have found over the years and after performing hundreds of anti-reflux surgery that a floppy two stitch Nissen fundoplication creates minimal resistance to esophageal emptying and is associated with a very low post-operative dysphagia rate. Scleroderma patients with zero motility may still benefit from partial fundoplication or in case they are obese a gastric bypass is offered.

In my opinion, Rick, you still have many options. I recommend you consult with an expert acid reflux specialist to complete your acid reflux evaluation and find the best heartburn solution that fits your particular condition to achieve the best outcome possible. Hope this brief synopsis helps.

Best,

Dr Darido.