York Thoracic Surgery
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ESOPHAGEAL SURGERY


Nissen Fundoplication:

 

 A Nissen Fundoplication is an elective surgical procedure that is meant to alleviate chronic reflux (also known Gastroesophageal reflux disease, GERD) in those who have not been able to control it with medication and lifestyle changes. It is also the treatment option in the repair of hiatus hernias. Gastroesophageal reflux is caused as a result of a weak muscle valve, called the cardiac sphincter, that separates the esophagus from the stomach. There is a burning sensation associated with this through the chest and throat. The esophagus is your swallowing tube, by which all food and drink passes on the way down to your stomach.

 

 In this surgery the upper portion of the stomach is wrapped all the way around the lower portion of the esophagus in order to restore the function of the stomach valve, thus stomach acid is prevented from rising into the esophagus in the case of reflux. The top portion of the stomach is prevented from slipping through the diaphragm in the case of hiatus hernia's. This procedure can sometimes be performed laparoscopically through a series of ports to reduce recovery time and scarring.

 

 This is a major surgery, and as with every major surgery there are risks. Some of the risks involved in a fundoplication are bleeding, leakage, infection, increased dysphagia, increased incidence of blood clots to the lung, heart (resulting in heart attack) or brain (resulting in stroke) and sometimes death.

 

 The operation carries with it moderate to severe pain which is controlled even before the surgery begins through a variety of methods. You may be given an Intravenous (I.V.) to control the pain, or an epidural which injects pain medication directly into the spine. Many of the pain reduction procedures are started prior to surgery to minimize the pain immediately after surgery.

 

 

 Before Surgery:


 As with any major surgery, there are pre-operative tests that must be taken in order to ensure the patient is ready for surgery. These tests make certain that your physician knows as much about your condition as possible which ensures the procedure will be performed as safely as possible. Some of these tests may include: (see the Pre-Surgery section for more details)

 

*     Blood Work

*     Cardiac Assessment

*     24 pH study

*     Esophageal Motility test

*     Gastroscopy

*     Pulmonary Functions Test 

*     Thoracic Surgery Lung School

 

 We ask that your Family Doctor fill in your Pre-Operative History & Physical Exam Record (found in your surgical package, form #3) and that it be returned to the surgical package envelope upon completion. Please notify our office or the admitting nurse upon arrival to surgery of any changes in your health after your Pre-Op History and Physical Exam were finalized.  

 

 You MUST NOT EAT OR DRINK anything after midnight the night before your surgery, only clear fluids (such as clear tea, black coffee, apple juice, ginger ale, Jell-O) may be consumed up to 4 hours before your admission time. Morning pills can be taken with a very small sip of water up until two hours before your admission time (NO milk, NO orange juice), after this time no fluids are allowed (not even water). Please be aware that this includes gum, candy and mints.

 

 

 Day of Surgery:

 

 Take your usual medication the morning of your surgery with a SIP of water unless instructed not to by your doctor. Please take a shower or bath and remove all make-up and nail polish and tie your hair back if it is long. Wear comfortable clothing which will be easy to put on after your surgery and wear your hearing aid and glasses instead of contacts.

 

 Please leave all cash, valuables and jewelry at home, since there are no lockers and the hospital assumes no responsibility for patient valuables. Also, please leave cell phones and electronic devices at home, as they CAN NOT be used in the hospital.

 

 

 Please bring with you:

*     Your surgical package with all the papers

completed inside

 

*     Your Ontario Health Card

 or

*     A list of all your current medications (including

herbal remedies). Please include dosage and times

taken per day.

                               

*     If you are currently taking any puffers, or

nitroglycerine (pills or spray), please bring them as

you may be asked to use them just before your

operation.

                                  

*     We ask that you bring a tote bag with your clean

bathrobe and slippers and since you will be staying

overnight bring your toiletries. Anything else you

might require during your hospital stay should be

brought by family members after your operation.

                      

 

Upon arrival to the hospital please proceed to Same-Day Admitting on the East end of the 2nd Floor of  Southlake Regional Health Centre. After registering, your family and friends will be asked to wait in the Surgical Admissions Waiting room on the 2nd Floor during your procedure.

 

 

 After Surgery:

 

    Please remember that every patient's recovery and recovery time is different depending on the individual and we can only provide approximate time frames and expectations.

 

 You will wake up from the anaesthesia in the Post-Anesthetic Care Unit (P.A.C.U., aka. Recovery Room), here you will spend several hours under close surveillance while recovering from surgery. You may wake up with a breathing tube down your throat; this tube will be removed soon after you are awake when you can breathe on your own. After the recovery room you will proceed up to the Surgical In-patient unit on the 5th Floor.

 

 You can expect to be in the hospital from anywhere between 1 to 2 days after surgery, where you will be monitored closely by the nurses and hospital staff. Bandages will cover the sites where the chest tube and incisions were; these are to be kept dry and kept in place for several days after returning home. After several days, you may wash the wounds with water and a mild soap (no bathing) and re-cover with dry gauze if there is any discharge. You must have a friend or relative present to take you home in order to be discharged from the hospital.

 

 Please do not hesitate to call our office if you are experiencing any excessive bleeding, wound discharge, pain, fever, dysphagia (difficulty swallowing), vomiting, if your prescription runs out or if you have any questions at all. If you are experiencing any of these problems and are not able to speak with someone in our office (ie. after business hours or on the weekend) and the problem is severe; please visit your local emergency room.

 

 You will have a post-surgery follow-up appointment booked with Dr. Toth, Dr. Lee, or Dr. Privitera in 4-6 weeks after your surgery. During this appointment you will discuss the operation and the final pathology results.