The Nissen Fundoplication

Abstract

The Nissen fundoplication is the most frequently performed antireflux procedure around the world. Technical details are important to prevent intraoperative complications and postoperative troublesome side-effects. If performed correctly the procedure, especially in the laparoscopic version, can be very effective and durable as antireflux therapy. After performing a technically correct fundoplication, an increased intragastric pressure will cause also a pressure increase within the fundic wrap. The wrap will have the ability to compress the distal esophagus helping to fulfill the task of an anti-reflux barrier. In addition, an increased intraabdominal pressure will create the similar effect. Therefore, an important technical prerequisite for a good result after a Nissen procedure is the anatomical reconstruction to ensure an intra-abdominal position of the sphincter as well as the symetric fundoplication. The first step is the dissection of the hiatus and the cardia. The second step is a sufficient mobilization of the esophagus in the mediastinum to position the LES in the abdominal pressure environment. The third step is the narrowing of the hiatus to an adequate width around the esophagus. The fourth important step is the shaping of the wrap. Each step is important in creating a functional good result with a long-lasting durability.