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Reversing a Nissen Fundoplication


Is it possible for surgery to be performed to un-do a Nissen Fundoplication?

Answer of our experts

Yes, although it is rarely done. The reason to re-explore a child who is post-Nissen is usually that the Nissen has slipped above the diaphragm, the most significant of which is a condition called para-esophageal herniation. This can be life-threatening. The other most common reason is that the Nissen no longer is working, has broken down, and requires repair. To re-operate to "un-do" a Nissen suggests that it wasn't necessary in the first place, or it was done incorrectly and needs correction

KK/TK 7-13-10

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Consider always gastro-oesophageal reflux disease (GORD) in any individual with CdLS owing to its frequency and wide variability in presentation, which includes challenging behaviour.
Modification of nutrition and proton pump inhibitors (PPI) are the first-line treatments of GORD. Anti-reflux medications need to be used to their maximum dosage. Surgical interventions for GORD should be limited to those individuals with CdLS in whom nutritional and medical treatments have been unsuccessful or airway safety is at risk.
If GORD symptoms persist, endoscopy should be strongly considered whilst an individual with CdLS is still in paediatric care.
Surveillance for Barrett’s Oesophagus needs to be discussed with and decided together with the family, balancing the potential gain in health and burden for the individual with CdLS.

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