What does the Nissen fundoplication procedure involve and how successful is it in treating recurrent heartburn?

In response to a question on healthshare.com.au

A fundoplication is an operation to wrap the top part of the stomach around the oesophagus, so that when the stomach fills it puts pressure on the oesophagus to decrease the amount of fluid that can reflux back up into the oesophagus.

The Nissen fundoplication (360 degree fundoplication) is one of the types of wrap; it is the most effective of the commonly-used techniques, but can be more prone to causing bloating and flatulence as it makes burping more difficult than some of the others such as a Toupet (270 degree) fundoplication. Some surgeons perform one type exclusively; many surgeons tailor the repair to the individual, depending on age and symptoms.

Either way, the surgery is usually performed laparoscopically (keyhole) with 4 or 5 small (5 to 15mm) incisions. The surgery takes from 45 minutes to 2 hours depending on the complexity, in particular if there is a large hiatus hernia then the surgery can take longer. It is usual to spend one or two nights in hospital after the operaton.

Recovery is usually fairly quick, with the exception of swallowing - it can take two months or more to feel completely comfortable with some foods. The incisions and the left shoulder are usually uncomfortable for two to three weeks, most people only experience significant pain for three or four days.

Most surgeons recommend a liquid diet for at least two weeks after surgery, then slowly progressing to mashed or pureed foods, then soft foods. This allows any swelling to settle and minimises the risk of vomiting.

It is important to avoid heavy lifting for 6 to 12 weeks following surgery, the exact time depends on whether a hiatus hernia was repaired.

About 85% of people who have a fundoplicaiton have sustained relief of their reflux symptoms. The relief is usually long-lived, with several research studies beyond 15 years showing good relief of symptoms for most participants. However, if a large hiatus hernia is present, up to 30% of people can have recurrent symptoms; occasionally further surgery is advised.