Nissen fundoplication

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Diagram of a Nissen fundoplication.

Image from laparoscopic Nissen Fundoplication - Pointing upwards towards the chest from the abdomen area. The three stitches next to the liver are closing up the hiatus (hole where esophagus passes through the diaphram), and the three stitches in the stomach secure the wrap (around the esophagus).

Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatus hernia. In GERD it is usually performed when medical therapy has failed, but in particular types of hiatus hernia (the paraoesophageal variant), it is the first-line procedure. A partial fundoplication may accompany surgery for achalasia (specifically, a Heller myotomy).

1 The procedure
2 Complications
3 History
4 External links

[edit] The procedure

In fundoplication, the fundus (upper part) of the stomach is wrapped, or plicated, around the inferior part of the esophagus, preventing the reflux of gastric acid (in GERD) or preventing the sliding of the fundus through the enlarged hiatus in the diaphragm. In a Nissen fundoplication, also called a complete fundoplication, the fundus is wrapped all the way around the esophagus.

Surgery for achalasia is generally accompanied by a partial fundoplication, either Dor and Toupet. In a Dor (anterior) fundoplication, the fundus is laid over the top of the esophagus. In a Toupet (posterior) fundoplication, the fundus is wrapped around the back of the esophagus.

The procedure is often done laparoscopically.

When used as a method to alleviate gastroesophageal reflux symptoms in patients with delayed gastric empyting, this procedure is frequently done in conjunction with modification of the pylorus via pyloromyotomy or pyloroplasty.

[edit] Complications

Complications include gas bloat syndrome, dysphagia (trouble swallowing), dumping syndrome, excessive scarring, and rarely, achalasia. The procedure can also become undone over time, leading to recurrence of the symptoms. If the symptoms warrant repeated surgery, the surgeon may use Marlex or another form of artificial mesh to strengthen the connection.