What is the success rate of Nissen (fundoplication) surgery?

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Last updated: August 22, 2025 • View editorial policy

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Success Rate of Nissen Fundoplication

Nissen fundoplication has a success rate of 80-90% for symptom relief in properly selected patients with gastroesophageal reflux disease (GERD), with long-term studies showing that the fundic wrap remains intact in 70-80% of patients 10-20 years after surgery. 1

Effectiveness for Different Symptoms and Conditions

Typical GERD Symptoms

  • 79-97% of patients experience complete relief of reflux symptoms 1, 2, 3
  • 85% of patients report Visick grade 1 or 2 symptoms (excellent or good results) 2
  • Actuarial analysis shows a 92% success rate at 20 years 2
  • 89% of patients would be willing to undergo the surgery again under the same conditions 2

Extraesophageal GERD Symptoms

  • Less predictable results for extraesophageal symptoms compared to typical GERD symptoms 4
  • Effectiveness for extraesophageal symptoms is variable, with systematic reviews showing inconsistent results 4
  • In patients with lung transplant and bronchiolitis obliterans syndrome with confirmed GER, fundoplication may improve lung function 4
  • In infants with persistent wheezing and confirmed GER, treatment (including fundoplication when indicated) can lead to significant improvement in 83-100% of cases 4

Factors Predicting Success

  • Prior response to PPI therapy: Patients who respond to PPI therapy before surgery have better outcomes 4
  • High acid exposure: Patients with high burden of acid reflux (acid exposure time >12%) have better surgical outcomes 4
  • Concomitant heartburn/regurgitation: Presence of typical GERD symptoms predicts better response to surgery 4
  • Intact fundic wrap: The main determinant of long-term outcome is an intact fundic wrap, observed in 70-80% of cases 10-20 years after surgery 1, 5
  • Adequate patient selection: Patients with mechanically defective sphincters on manometry and increased esophageal acid exposure on 24-hour pH monitoring have better outcomes 3

Complications and Side Effects

  • Perioperative mortality rate: 0.8-2% 6, 2
  • Technique-related morbidity: 1.9-2% 6, 2
  • Conversion to open procedure: 0.8-6% 6, 3
  • Post-operative side effects affecting 9% of patients 2:
    • Dysphagia: Present in up to 43% of patients but usually resolves within 2-3 months 5
    • Increased flatus: Common but rarely disturbing 1
    • Bloating: Often decreased rather than increased after fundoplication 1
    • Gas-bloat syndrome, flatulence, and diarrhea: Reported in 3.6% of patients 6

Failure and Recurrence

  • Failure rate: 1.2-5% 6, 3
  • Recurrent reflux requiring reoperation: 1-2% 3
  • Defective fundic wrap: Found in 20-30% of patients at long-term follow-up 1, 5
  • Esophagitis recurrence: More common in patients with defective wrap (58%) than those with intact wrap (5%) 5

Post-Operative Complications

Common complications that may require management include 7:

  • Tight wrap causing obstruction
  • Slipped wrap
  • Paraesophageal hernia (5-43% of post-fundoplication patients)
  • Delayed gastric emptying
  • Dumping syndrome

Clinical Algorithm for Patient Selection

  1. Confirm GERD diagnosis with objective testing:

    • Endoscopy to assess for esophagitis or Barrett's esophagus
    • 24-hour pH monitoring to document abnormal acid exposure
    • Manometry to evaluate esophageal motility

  2. Identify optimal surgical candidates:

    • Patients with documented GERD who respond to PPI therapy
    • Patients with high acid exposure (>12% acid exposure time)
    • Patients with typical GERD symptoms (heartburn/regurgitation)
    • Patients with adequate esophageal peristalsis

  3. Consider surgery with caution in:

    • Patients with extraesophageal symptoms only
    • Patients who don't respond to PPI therapy
    • Patients with poor esophageal motility

  4. Ensure proper follow-up:

    • Endoscopy at 2-3 months post-surgery
    • Annual esophagogram
    • Prompt evaluation of recurrent symptoms

Conclusion

Nissen fundoplication is highly effective for typical GERD symptoms in properly selected patients, with success rates of 80-90%. The procedure is less predictable for extraesophageal symptoms. Patient selection is critical, with the best outcomes seen in those who respond to PPI therapy, have high acid exposure, and present with typical GERD symptoms. Long-term success depends on maintaining an intact fundic wrap, which occurs in 70-80% of patients after 10-20 years.

References

4
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

7
Guideline

Post-Nissen Fundoplication Complications

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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