Revision Nissen Fundoplication: Options and Outcomes

Question of the Week: Revision Nissen Fundoplication – Options and Outcomes

Question of the week: I am a 67-year-old female. My GERD symptoms peaked in 2014 when I had a Nissen fundoplication in Cleveland Ohio. The procedure failed at the end of the first year or so and my symptoms have returned even greater than before the surgery. I have an appointment in Cleveland for testing, Upper GI scope, July 10th and then a consult with the surgeon on the same day. This surgeon says my only option is a Roux-en-Y procedure. Are there any other options. Thank you

Dear Joyce,

I am sorry your Nissen fundoplication has failed one year after surgery. This is quite unusual. The success and durability of Nissen fundoplication have been established by numerous published studies as well as our own data analysis at Houston Heartburn and Reflux center. Nissen fundoplication durability and effectiveness hinges on 3 crucial management guidelines:

1- Proper patient selection
2- Solid and comprehensive GERD workup
3- Flawless surgical technique.

If anyone one of these key factors is violated, Nissen fundoplication surgery is not likely to succeed. There are no shortcuts in acid reflux management. At Houston Heartburn and Reflux Center, we go far and beyond to make sure your Nissen fundoplication is nothing less than PERFECT. Only then you can expect high success rates and reliable outcomes.

The first step in evaluating your case, Joyce, is to obtain all previous records including operative report. Your file is then carefully reviewed and an extensive face to face consultation is conducted. We need to understand your symptoms, and what kind of pre-surgery testing you had undergone. We then order specific tests to your condition that may include upper endoscopy, ambulatory pH testing, and upper gastrointestinal contrast study. Revision Nissen fundoplication is offered if we demonstrate that one or more of the three GERD management guidelines have been violated. We typically find evidence of increased esophageal acid exposure in the setting of recurrent hiatal hernia and slipped Nissen fundoplication. A number of technical factors contribute to Hiatal hernia recurrence and gastric wrap break down or slippage. In the majority of cases, incomplete mobilization of distal esophagus and gastric fundus is found. Revision Nissen fundoplication surgery remedies these issues and results in very good outcomes. In these situations, there is no need to proceed with Roux-en-Y procedure unless the patient is morbidly obese (at least 100 pounds over ideal body weight). Obesity limits our ability to properly dissect and mobilize the esophagus, a key step in Nissen fundoplication surgery. Furthermore, weight loss is an integral part of acid reflux management. Consequently, a Roux-en-Y gastric bypass is indicated in obese patients with a failed Nissen fundoplication.

To summarize, Nissen fundoplication surgery has to be PERFECTLY executed to work. When properly performed, Nissen fundoplication is the most reliable treatment for acid reflux disease. Houston Heartburn and Reflux Center is dedicated to GERD management. Strict and clear GERD management guidelines along with compassionate patient care guaranty excellent Nissen fundoplication outcomes.