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A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. In GERD, it is usually performed when medical therapy has failed; but, with a Type II (paraesophageal) hiatus hernia , it is the first-line procedure.
Fecal occult blood testing (FOBT), as its name implies, aims to detect subtle blood loss in the gastrointestinal tract, anywhere from the mouth to the colon.Positive tests ("positive stool") may result from either upper gastrointestinal bleeding or lower gastrointestinal bleeding and warrant further investigation for peptic ulcers or a malignancy (such as colorectal cancer or gastric cancer).
Diagnosis is often based on direct observation of blood in the stool or vomit. Although fecal occult blood testing has been used in an emergency setting, this use is not recommended as the test has only been validated for colon cancer screening. [19] Differentiating between upper and lower bleeding in some cases can be difficult.
Acid reflux into the mouth can cause breakdown of the enamel, especially on the inside surface of the teeth. A dry mouth, acid or burning sensation in the mouth, bad breath and redness of the palate may occur. [27] Less common symptoms of GERD include difficulty in swallowing, water brash, chronic cough, hoarse voice, nausea and vomiting. [26]
The Nissen fundoplication procedure consists of a 360 degree transabdominal fundoplication. A fundoplication is the suturing of the fundus located in the stomach and around the esophagus. [5] The procedure itself is performed with the patient in a low lithotomy position at approximately 25 degrees.
The stomach fundus can then be wrapped around the neo-esophagus, thus reducing reflux of stomach acid into the esophagus. In fact, gastroplasty can be used when the length of the intra-abdominal esophagus is short and for anti-reflux action such as Nissen fundoplication, it is necessary to increase the intra-abdominal length of the esophagus.
Blood may be observed in vomit or in altered form as black stool. Depending on the amount of the blood loss, symptoms may include shock. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and rarer causes such as gastric cancer. The initial assessment includes measurement of the blood pressure ...
Nissen fundoplication: Rudolph Nissen: Upper gastrointestinal surgery, laparoscopic surgery: Gastric fundus is wrapped fully around the lower oesophagus to treat gastroesophageal reflux disease: Nissen's fundoplication at Who Named It? Paul's operation: Frank Thomas Paul (1851–1941) Colorectal surgery: Extra-abdominal resection of colon [6 ...