Nissen Fundoplication Surgery

A surgical procedure called Nissen fundoplication can treat acid reflux in people with spinal muscular atrophy (SMA). Acid reflux happens when stomach material travels back into the esophagus. This can lead to inhalation of stomach material into the lungs.

A Nissen fundoplication prevents reflux by tightening the muscle between the stomach and the esophagus (swallowing pipe). The procedure is now often done while inserting a gastrostomy tube for feeding. There are few complications, and studies so far have shown positive outcomes.

When do people with SMA need a Nissen fundoplication?

People with severe types of SMA often have gastroesophageal reflux disease (GERD). This is also called acid reflux. It happens when liquid or food in the stomach travels back up into the esophagus and mouth.

Acid reflux can cause uncomfortable heartburn. It can also lead to inhalation (aspiration) of stomach contents into the lungs.^1,2

A nutritionist can suggest ways to help with GERD. This may include diet changes, such as avoiding high-fat foods and other irritating foods. It may also involve certain medicines. These treatments reduce damage to the esophagus.³

If these treatments do not work, doctors may recommend a Nissen fundoplication for serious acid reflux. This procedure is now usually done when a gastrostomy tube (G-tube) is placed. Newer techniques allow both to be done at the same time. This helps reduce recovery time.^3,4

The decision to perform a Nissen fundoplication depends on the severity of reflux and aspiration, as well as other personal factors. Doctors may perform several tests to determine if the procedure is needed.

For example, they can assess the severity of reflux using a test for stomach acid in the esophagus. This involves placing a tube through the nose into the esophagus that contains a pH probe. They can perform this test to see acid reflux in different situations.³

What can I expect during a Nissen fundoplication?

A Nissen fundoplication is a surgery that makes it harder for stomach material to travel back from the stomach. During the procedure, doctors wrap the top part of the stomach around the lower part of the esophagus. This tightens the muscle connecting the stomach and esophagus to prevent reflux.^2,5

The procedure is usually done using a “laparoscopic” procedure. This is a minimally invasive procedure. Doctors make small cuts to insert a tiny camera that allows them to see inside the body.⁵

The entire procedure takes 2 to 3 hours. Following the procedure, ventilation with bi-level positive airway pressure (BiPAP) may be needed, usually for less than 24 hours. The length of stay in the hospital can vary but is usually 3 to 4 days. People can usually return to normal activities within a few weeks.⁵

What are the outcomes of a Nissen fundoplication?

The procedure usually prevents further reflux and has few side effects. It also removes any need for long-term drugs for acid reflux. There is not yet much research on Nissen fundoplication for people with SMA. Some small studies of people with type 1 or 2 SMA have shown that the procedure:^6,7

• Reduces the rate of pneumonia (lung infection)
• Reduces the number of hospitalizations
• Improves weight gain