Nissen vs Anterior Fundoplication Surgery for Acid Reflux
Over the last decade, surgeries for the treatment of serious Gastroesophageal Reflux Disease (GERD) have both advanced in technique and popularity. Surgery is not a front-line heartburn treatment but rather something considered after traditional techniques fail.
In this article, you will discover the differences between two of the most common types of GERD surgery: Nissen Fundoplication and Anterior Fundoplication, including differences in procedure, effectiveness, side effects, and long-term success rates.
Nissen Fundoplication vs Anterior Fundoplication – Differences in Procedure
Nissen Fundoplication and Anterior Fundoplication are very similar procedures using similar techniques, differing in the severity of the surgery.
Both techniques involve taking a piece of the stomach (known as the fundus), and “wrapping” it around the esophageal valve (entryway to the stomach from the esophagus). In a patient without acid reflux, the Lower Esophageal Sphincter (LES) applies enough pressure at this point in the body to keep the stomach sealed. When it cannot apply enough pressure, reflux results.
Both Nissen and Anterior Fundoplication are designed to help reinforce this structure. The difference is in how much they reinforce the structure.
Nissen Fundoplication involves pulling a posterior portion of the top of the stomach (the fundus), and wrapping it completely around the lower esophagus, and then surgically attaching this portion to the front of the stomach. This is a full 360-degree wrap around the lower esophagus, and as such it is often referred to as a complete fundoplication or a 360-degree fundoplication.
The Anterior Fundoplication, on the other hand, is a similar procedure, but does not use a full 360-degree wrap. Typically, Anterior Fundoplication refers to a 180-degree wrap (unless otherwise stated), where only “half” of the lower esophagus is wrapped by the stomach.
These two surgeries, as a result, have different success rates and side effects, which you will find out below.
Differences in Effectiveness Between GERD Surgeries
While these surgeries have been done for a few decades now, only in the last decade has this surgery become more prevalent and only recently have laparoscopic techniques been able to be perform anterior fundoplication laparoscopically. As a result, only recently that longitudinal studies (studies which track patients’ symptoms and side effects over a period of months to years) have begun to surface.
Researchers in a study published in May 2011 studied over 100 total patients, tracking them anywhere from 6 months to up to nearly 3 and a half years. They reported that patients who had anterior fundoplication still used antacids more frequently than those who had Nissen Fundoplication (34.2% for anterior, 17.4% for Nissen) (1).
Overall, 72% of the patients studied reported a positive experience with their procedures (1). Some older studies have reported satisfaction rates of up to 94% (2), though more modern reports reviewed suggest similar success rates to the first study.
Differences in Recovery Times and Side Effects of GERD Surgery
Between the two surgeries, the same study reported that patients who had Anterior Fundoplication had faster recovery rates (measured in terms of less days in the hospital following surgery) (1). However, the authors suggested that this difference may simply be due to advances in laparoscopic surgery rather than differences in the two procedures (1).
However, what was noted as a significant difference between the two was the side effect of inability to belch. This is a known, painful side effect of acid reflux surgery. In this condition, the fundoplication reinforces the esophagus to such an extent that the pressure is too great to belch, or remove excess gas from the stomach.
Given that the Nissen Fundoplication is a stronger reinforcement than the Anterior Fundoplication, the Nissen procedure resulted in inability to belch more frequently than the Anterior procedure (1).
This side effect can be extremely painful. For some patients, it is self-correcting within 4 weeks following surgery, while in other patients it does not go away without corrective surgery or procedures. Regular swallowing of air when eating, talking, or drinking can cause serious pain, flatulence, and discomfort in affected individuals. Carbonated beverages also cannot be drank when suffering from this condition.
However, while risk rates for developing this condition are lower in Anterior Fundoplication than Nissen Fundoplication, both procedures have been reported to result in this condition (1, 2).
Differences in Acid Reflux Surgeries – Summary
At a basic level, the Nissen Fundoplication is a stronger version of the Anterior Fundoplication. Both procedures have been shown by researchers to be effective at reducing or eliminating acid reflux (1). Since the Nissen Fundoplication is a strong reinforcement, it tends to be both more effective and more susceptible to side effects (like the inability to belch) (1).
In the end, you should reach a decision with your doctor and surgeon on which procedure to have performed (if any procedure is performed at all). Both procedures are not without risks. Surgery is not considered by the mainstream medical community to be a first-line defense for acid reflux, but rather it is recommended that all other options be exhausted first before opting for surgery (though there may be exceptions to the rule).
Lifestyle changes such as weight loss and an acid reflux diet plan, perhaps in conjunction with medication or occasional use of an antacid or heartburn remedies, are typically enough to solve the acid reflux needs of most people.
References
1. Cartlidge CW, Stewart GD, de Beaux AC, Paterson-Brown S. The evolution of laparoscopic antireflux surgery and its influence on postoperative stay. Scott Med J. 2011 May;56(2):64-8.
2. Mir J, Ponce J, Juan M, Garrigues V, Ibañez JL, Berenguer J. The effect of 180 degree anterior fundoplication on gastroesophageal reflux. Am J Gastroenterol. 1986 Mar;81(3):172-5.
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