The surgery for this can be done as an outpatient surgery, but you may have to stay the full 23 hours or even over night. It all depends on how you are swallowing and your pain is.
With the Nissen they detach the upper part of your stomach, fundus, from the spleen and wrap that section around the area where your stomach and esophagus connect, the LES. They also will fix any overly large hernia you may have at that time. Normally this can be done as a lap surgery, but if things aren't ideal they may have to do it as an open surgery. It usually takes about 1.5 to 2.5 hours for the surgery.
What makes it a major surgery and last resort is because it has a fairly long recovery and diet restrictions until things are healed. this can be as long as a year for full healing and effect. Most are doing very well at 4 to 6 months, but some can take longer. You also may not be able to vomit and have a difficult time burping. Until things are healed well and the swelling goes down you also may have a hard time swallowing solid foods.
There are a few other options available too. The Linx is showing good results and they are working on trials for a device to implant a device to stimulate the LES to tighten it.
Before going this route you need to have tests done to see how much you are refluxing and if you are a good candidate for the surgery. Tests are, EGD, Manometry, PH study. With these they may also want a barium swallow or stomach emptying test.
No surgeon should do this surgery without having the 1st 3 tests. If you were to have a swallowing function issue and they do this surgery it will be much worse, so a manometry is needed. They also need to know how much you are refluxing and a PG study shows that. The EGD shows them exactly what the inside of your stomach and esophagus looks like and they can do biopsies to test for a few other things like barrets esophagus and H-Pylori.
Before letting a surgeon do this surgery be sure they have done 100s to 1000s of them successfully. Successfully is the key here. Also find out if they do redoes in case you would ever need it in the future.
Moderator: GERD/Heartburn, Kidney disease
Nissen 6/06 and 5/09