43280 Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures)

Name of the Procedure:

Laparoscopy, surgical, esophagogastric fundoplasty (e.g., Nissen, Toupet procedures)

Summary

Laparoscopic esophagogastric fundoplasty, commonly referred to as Nissen or Toupet fundoplication, is a minimally invasive surgical procedure to treat gastroesophageal reflux disease (GERD). During the surgery, the upper part of the stomach is wrapped around the lower esophagus to prevent acid reflux.

Purpose

The procedure aims to:

• Treat GERD and associated symptoms such as heartburn, regurgitation, and difficulty swallowing.
• Prevent complications like esophagitis, esophageal strictures, or Barrett’s esophagus.

Indications

• Persistent GERD symptoms despite medical treatment.
• Esophagitis (inflammation of the esophagus).
• Hiatal hernia.
• Complications from GERD, such as strictures or Barrett’s esophagus.
• Patient preference for a surgical treatment over long-term medication.

Preparation

• Fasting typically required for 8-12 hours before the procedure.
• Medication adjustments may be necessary; blood thinners often need to be paused.
• Preoperative diagnostic tests, such as upper endoscopy, pH monitoring, or esophageal manometry, may be required.

Procedure Description

1. The patient is placed under general anesthesia.
2. Small incisions are made in the abdomen to insert a laparoscope and other surgical instruments.
3. The upper part of the stomach (fundus) is wrapped around the lower esophagus.
   • In Nissen fundoplication, a 360-degree wrap is created.
   • In Toupet fundoplication, a partial 270-degree wrap is formed.
4. The stomach is stapled or sutured in place to secure the wrap.
5. The incisions are closed with sutures or surgical tape.

Duration

The procedure typically takes 2 to 4 hours.

Setting

The procedure is performed in a hospital operating room or surgical center.

Personnel

• General surgeon or a specialist in gastrointestinal surgery.
• Anesthesiologist.
• Surgical nurses.
• Possible presence of a surgical technician.

Risks and Complications

Common risks:

• Infection at the incision sites.
• Temporary difficulty swallowing.

Rare risks:

• Damage to surrounding organs (esophagus, spleen, liver).
• Gas bloat syndrome.
• Recurrence of GERD symptoms.
• Need for reoperation.

Benefits

• Significant reduction or complete relief from GERD symptoms.
• Less dependence on long-term medication for acid reflux.
• Reduced risk of complications associated with chronic GERD.

Recovery

• Hospital stay of 1-3 days post-surgery.
• Gradual increase in diet starting with liquids, then soft foods, and eventually regular diet.
• Avoid heavy lifting and strenuous activity for 4-6 weeks.
• Follow-up appointments to assess recovery and ensure the wrap remains intact.

Alternatives

• Lifestyle and dietary modifications.
• Medications like proton pump inhibitors (PPIs) or H2 receptor blockers.
• Endoscopic procedures for reflux management.

Comparison: Alternatives might be less invasive but may not provide as long-lasting relief as surgical intervention.

Patient Experience

• During the procedure: Patient is under general anesthesia and will not be conscious.
• After the procedure: Mild to moderate pain at incision sites, managed with pain medication. Temporary sore throat from the anesthesia tube.
• Gradual return to normal activities with specific restrictions to ensure proper healing.