If you're one of the 60 million Americans who experiences heartburn two or more times per week for at least three months, there is a chance you have gastroesophageal reflux disease (GERD). If so, there are a number of ways to get treated. The first are lifestyle changes, which include:

  • Losing weight
  • Changing your diet
  • Altering your sleep habits
  • Reducing your stress level

The second way is with drug therapy or over-the-counter medicines. There are three kinds of these:

1. Antacids (like TUMS)

2. H2 receptor antagonists (Pepcid AC)

3. Proton pump inhibitors (Prilosec)

There is a chance, however, that none of these will be sufficient, or that you will not respond well to any of these treatments. And in that case, there is a more serious treatment: surgery.

One of these is the Nissen fundoplication, commonly referred to Nissen surgery. It is named after a German surgeon, Rudolph, Nissen, who invented the procedure in the early 20th Century. The Nissen surgery works by wrapping the distal esophagus with the uppermost part of the stomach. Between the esophagus and the stomach is a valve called the lower esophageal sphincter (LES). The LES plays an essential role in people with GERD. When you eat, the LES opens, allowing food to enter your stomach, then closes, stopping food from backing up into your esophagus. When the LES opens more than it should, or at the wrong times, reflux occurs. What the Nissen surgery does is strengthen the LES, helping to function normally and ensuring that reflux cannot take place.

In its initial trials, the Nissen surgery carried a high morbidity rate. The incision was long, extended from just below the ribs to the bellybutton. Hospital stays were 7 to 10 days, and recovery time lasted 6 to 12 weeks.

Eventually, laparoscopic procedures were introduced, rendering the Nissen surgery one done with minimally invasive techniques. Now, according to the National Institutes of Health Information Clearinghouse, "patients have small incisions, have less pain, leave the hospital sooner, and return to normal activity sooner." [1]

Thus for the Nissen surgery, the success rate, which measures the patients' relief of the primary symptoms, is very high. In survey reports, patients have proven to be very satisfied. For example, at the University of Washington there have been 250 antireflux surgeries, the majority being the Nissen surgery. The success rate is greater than 90 percent, and patients return to work in an average of 3 days.[2]

Despite how common it is in treating those with GERD, the Nissen surgery remains a procedure that is only done if necessary. And the only way the figure out whether it is necessary is to see your doctor.


[1] http://diabetes.niddk.nih.gov

[2] http://depts.washington.edu