April 25, 2017

FAQs- Nissen

What kind of results can I expect with the Nissen?
While every patient’s results will depend on their specific history and anatomy, a 10 year Nissen study results reported in the Annals of Surgery showed that after laparoscopic surgery:

  • GERD symptoms were relieved in 92% of patients
  • 73% of patients were completely off PPIs, 13% of patients required daily use of PPIs and 9% of patients were on PPIs only as needed
  • 99% of patients had relief from regurgitation
  • 79% of patients would have the surgery again

Will I be able to belch or vomit with Nissen?
A separate 10 year study reported in the World Journal of Gastroenterology noted 31% of patients could not vomit and 61% of patients had decreased belching ability. A 15 year study published in Annals of Thoracic Surgery reported that 21% of laparoscopic Nissen patients experienced mild or no issues with gas and bloating while 46% experienced severe or difficult issues.

When can I start eating normally again?
Patients are given a special post-operative diet to follow which takes them from clear liquids to liquids to soft foods to regular foods. Generally, you will be on soft foods for 4 to 6 weeks, depending on how you are healing.

I’ve heard patients have trouble swallowing after surgery. How do I avoid or deal with that?
Difficulty swallowing (dysphasia) is a common and expected side effect of the surgery. Patients are encouraged to follow the post-operative diet and eat or drink small amounts 5-6 times a day versus 3 regular meals during the first 3 months.

How soon after the procedure can I resume normal physical activities?
Patients are generally able to return to non-strenuous activity within a couple of days and more strenuous activities within a few weeks. Specific restrictions will be dependent on your surgeon’s instructions.

How long is the procedure?
The Nissen procedure typically takes an hour. If you are having a hiatal hernia repaired during the surgery, the procedure could take longer depending on the size and complexity of your hernia. Patients generally go home 1-2 days after surgery.

What are the risks associated with the Nissen surgery?  
While all surgical procedures have risks, such as the risk of infection, bleeding and reactions to anesthesia, the most common side effects of the Nissen surgery are difficulty swallowing, post-operative pain and temporary bloating of the stomach. Your surgical team will discuss the risks with you prior to  your surgery.

How long will my Nissen last?
Studies have shown the Nissen can last 20+ plus years.

Is there any chance my reflux will return if I gain a lot of weight after the procedure?
Weight gain increases the pressure inside the abdomen, so it is possible that significant weight gain can create more pressure than the Nissen can counteract, leading to the return of reflux symptoms.

Will my insurance company pay for Nissen?
While coverage and patient costs are dependent on your specific insurance carrier and policy, nearly all insurance companies pay for antireflux surgery. Your clinical team will work with your insurance company to obtain pre-authorization for the procedure.

I had weight loss surgery and still have reflux. Am I a candidate for a Nissen?
Patients who have had sleeve gastrectomies and are still experiencing reflux should consult with their surgeon for options. Generally, a Nissen would not be possible due to the lack of fundus after a sleeve.

I had a Nissen and now want weight loss surgery. Am I a candidate for weight loss surgery?
As long as further testing doesn’t exclude you, you may be a candidate for a weight loss operation. Patients should note this is a very difficult operation and should seek surgeons who are experienced in this type of operation.

If my Nissen surgery isn’t effective, what are my options?
As long as further testing doesn’t exclude you and proves that reflux is present, another Nissen or a “re-do” may be performed. Patients should note a redo may be more complicated due to scar tissue from the previous Nissen.

I know I have GERD and feel better on medications. Why do I need additional testing before the procedure?
Esophageal motility testing (manometry) is needed to ensure the muscles in the esophagus generate enough pressure to push the food past the Nissen augmented LES. Twenty-four hour pH testing is used to measure when, and for how long, acid is refluxed into the esophagus to prove that your symptoms correlate with actual reflux events.  An upper GI procedure or barium swallow is used to define your anatomy and help diagnose a hiatal hernia. Additionally, your insurance company may require some or all of the testing in order to pay for the procedure.