Nissen Fundoplication/Paraesophageal Hernia Repair

Treating GERD and hiatal hernias with minimally invasive surgery

Nissen fundoplication is a surgical procedure used to treat gastroesophageal reflux disease, or GERD, and hiatal hernia. It tightens and reinforces the sphincter at the top of the stomach to prevent stomach acid from rising into the esophagus.

A hiatal hernia (paraesophageal/diaphragmatic hernia) is when part of the stomach extends up through the diaphragm and into the chest. This condition can cause severe acid reflux or GERD symptoms. Often, these symptoms can be treated with medications, but if those don’t work, your doctor may offer surgery as an option.

Nissen fundoplications and paraesophageal hernia repairs are often done together. Hiatal hernia surgery corrects the hernia by pulling the stomach back into the abdomen and making the opening in the diaphragm smaller, while the fundoplication tightens the lower esophageal sphincter. Our surgeons use minimally invasive techniques, including robotics, to perform the procedure. The type of method chosen will vary according to the particular health condition.


Do you need a Nissen fundoplication/paraesophageal hernia repair?

To determine whether you need this procedure, your doctor might perform a variety of diagnostic tests and procedures including:

How to prepare for fundoplication/paraesophageal hernia repair surgery

Prior to the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure.

Talk to your doctor about:

  • All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each
  • Radiation exposure, especially for those that are pregnant
  • Any allergies to medicines, latex, tape, iodine, and anesthetic agents
  • Any history of bleeding disorders
  • Any body piercings on your chest or abdomen

Checklist of things to do before surgery

  • Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
  • Leave all jewelry at home.
  • Remove all makeup and nail polish.
  • Wear comfortable clothing when you come to the hospital.
  • If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to expect during a Nissen fundoplication procedure/paraesophageal repair

The surgery will typically take between 2 to 3 hours to complete. It is typically performed in the cardiothoracic operating room. Check with your doctor about the details of your procedure. In general:

  • You will change into a hospital gown.
  • A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
  • Usually, your doctor will administer anesthesia (will make you feel sleepy).
  • Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
  • The doctor makes a few tiny incisions in the abdomen.
  • The doctor inserts a laparoscope (thin tube with a light and a camera) to help repair the hernia and tighten the stomach opening to prevent the hernia from coming back.
  • The doctor will close up the incision(s) with stitches or staples, and you will be moved to the recovery area.

What to expect after fundoplication/paraesophageal hernia repair

After the surgery, patients usually stay in the hospital for 1 to 2 days. In general:

  • The breathing tube is removed when you wake up from anesthesia. A small tube in the nose drains fluid and gas from the stomach. When the tube is removed (usually same day or surgery if early or the next day), you may have liquids.
  • Urine catheters and drainage tubes (chest tubes) are removed after 24 hours.
  • You are encouraged to be out of bed and to walk as much as possible.
  • You will need to follow a specific diet after a Nissen fundoplication. Your doctor will talk with you about it, and provide any other postsurgery instructions before you go home.

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