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 'Nissen Lap' Videoscopic Procedure Can Relieve Chronic Heartburn
Frequently Asked Questions
A videoscopic surgical procedure can provide permanent relief for chronic heartburn sufferers who have gastroesophageal reflux disease.
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Dr. Tim Deaconson |
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The procedure, called a Lap Nissen Fundoplication or Nissen Lap, usually can be accomplished with a brief hospital stay and a few small incisions. Dr. Tim Deaconson, a general surgeon at Kneibert Clinic, was among the first in the U.S. to perform the technique and has presented his work at a national meeting of his peers. He has performed the procedure about 100 times.
Deaconson, dually board certified by the American Board of Surgery in both General Surgery and Surgical Critical Care, was highly decorated during a distinguished career as a U.S. Army Surgeon. His clinical skills and personal leadership are nothing short of the best ever seen, his commanding officer stated after Operation Desert Storm.
It was while in the Persian Gulf that Deaconson learned the Nissen Lap in 1991 and brought the technique to the U.S. when he returned in 1994. First performed by Dr. Rudolph Nissen in 1951, the technique used to require an incision about 10 inches long and a lengthy hospital stay. Today, however, Nissen fundoplication can be performed laparoscopically with five small incisions.
During the procedure, the surgeon wraps the top portion of the stomach around the lower esophagus to recreate the lower esophageal sphincter, which is the opening to the stomach. The technique effectively prevents stomach acids from finding their way into the esophagus. In patients with gastroesophageal reflux disease, the valve that usually keeps stomach acids in their place becomes too weak to do the job.
Left untreated, the disease can cause esophageal bleeding, esophageal ulcers and narrowing of the esophagus as well as chronic heartburn.
The procedure can also be used to treat a similar problem caused by a hiatal hernia, when a portion of the stomach bulges past the diaphram.
Studies show that 90 percent of patients become symptom-free after surgery.
While effective, the procedure isn't for everyone. Videoscopic surgery is an option for selected patients with severe chronic heartburn that disrupts their lives despite lifestyle changes and medication.
Other heartburn sufferers who may benefit from the procedure include younger patients (under 50) facing a lifetime of medications, patients who find medications a financial burden, patients who are non compliant with their drug regimen, and patients who prefer a single intervention to long-term therapy.
As with all surgical procedures, there are risks and side effects, though most are minimal. Additional information about the procedure can be found here.
The Laparosc opic Surgical Procedur e (from top):
1) Lifting the esophagus: If the opening of the hiatus is too large (hiatal hernia), the surgeon may tighten it with a few stiches. This repairs the hiatal hernia. Then the esophagus is lifted out of the way for a short time.
2) Wrapping the top of the stomach around the esophagus: The surgeon wraps the very top of the stomach around the outside of the esophagus. This added support helps prevent reflux. To make sure the wrap is not too tight, a flexible rubber tube may be temporarily inserted into the esophagus.
3) Choosing the wrap: Next the wrap is permanently stitched in place, a full wrap is shown. Another commonly used wrap is a partial wrap, which does not go all the way around the esophagus.
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