Rona in Sugarland Texas sent us this question: “I have had a Nissen fundoplication & hiatus hernia repair. I am 25 weeks pregnant and have got heartburn. Does it mean my fundoplication has come undone? Thank you.”
Dear Rona,
Nissen fundoplication reliably and effectively eliminates acid reflux and heartburn. Therefore, heartburn or food regurgitation in the setting of Nissen fundoplication and hiatal hernia repair may indicate wrap failure. Pregnancy increases intra-abdominal pressure. In the setting of a partially undone or poorly performed Nissen fundoplication, heartburn and acid reflux may occur.
Upper endoscopy and ambulatory pH testing are recommended to check for acid reflux, evaluate the integrity of Nissen fundoplication and rule out a recurrent hiatal hernia. Obviously, the workup for acid reflux and potential revision surgery are postponed till after delivery. Lifestyle changes including head of bed elevation and avoiding trigger foods like spices and tomato sauce may help alleviate symptoms. Eating small meals and avoiding excessive weight gain also help reduce acid reflux severity and frequency. Antacids like Tums and Maalox control severe attacks of heartburn. Additional medications to reduce stomach acidity may be prescribed by your obstetrician.