Esophagogastric fundoplasty, with fundic patch (Thal-Nissen procedure)
CPT4 code
Name of the Procedure:
Esophagogastric Fundoplasty, with Fundic Patch (Thal-Nissen Procedure)
Summary
The Esophagogastric Fundoplasty, also known as the Thal-Nissen procedure, is a surgical technique designed to treat conditions related to the esophagus and stomach. This procedure involves wrapping the top part of the stomach (the fundus) around the lower end of the esophagus, helping to control reflux and repair any existing damage.
Purpose
The primary purpose of the Thal-Nissen procedure is to treat gastroesophageal reflux disease (GERD) and hiatal hernias. The procedure aims to:
- Prevent acid reflux.
- Repair a hiatal hernia.
- Restore normal functionality to the lower esophageal sphincter (LES).
Indications
Patients who may benefit from the procedure generally experience:
- Chronic GERD symptoms unresponsive to medication.
- Hiatal hernia causing severe reflux.
- Complications such as esophagitis, Barrett’s esophagus, or stricture.
- Significant impairment in quality of life due to persistent reflux symptoms.
Preparation
Prior to the procedure, patients may be instructed to:
- Fast for at least 8 hours.
- Adjust or discontinue certain medications as advised by their doctor.
- Undergo diagnostic tests such as endoscopy, esophageal manometry, and pH monitoring.
Procedure Description
- The patient is placed under general anesthesia.
- Small incisions are made in the abdomen to allow for the insertion of laparoscopic instruments.
- The surgeon gently pulls the upper part of the stomach, called the fundus, around the lower esophagus to create a new valve mechanism.
- In the Thal-Nissen modification, a partial wrap (270 degrees) is created with a fundic patch to reduce the risk of dysphagia.
- The wrap is secured using sutures.
- The incisions are closed with stitches or surgical glue.
Duration
The procedure typically takes around 1 to 2 hours.
Setting
This procedure is performed in a hospital or surgical center's operating room.
Personnel
The healthcare team typically includes:
- A skilled surgeon trained in laparoscopic or general surgery.
- An anesthesiologist to administer general anesthesia.
- Surgical nurses and technicians to assist during the procedure.
Risks and Complications
Risks include:
- Bleeding or infection.
- Damage to surrounding organs.
- Difficulty swallowing (dysphagia).
- Gas bloat syndrome.
- Recurrence of reflux or hernia.
Benefits
The expected benefits include:
- Significant reduction or elimination of GERD symptoms.
- Healing of esophagitis.
- Prevention of further complications from acid reflux.
- Improved quality of life, often noticeable within weeks.
Recovery
Post-procedure care involves:
- A short hospital stay (1-2 days) for monitoring.
- Gradual reintroduction of liquids and soft foods.
- Avoidance of heavy lifting and strenuous activities for several weeks.
- Follow-up appointments to monitor recovery and ensure the procedure's success.
Alternatives
Alternative treatments include:
- Medication (proton pump inhibitors, H2 blockers).
- Lifestyle modifications (dietary changes, weight loss).
- Endoscopic procedures (e.g., Stretta procedure). Each alternative has its own pros and cons concerning invasiveness, effectiveness, and potential side effects.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel anything. Post-operatively, the patient might experience discomfort, mild pain, and a feeling of fullness. Pain can be managed with medications, and specific measures will be taken to ensure comfort during the recovery period.