March 25, 2017

Nissen fundoplication

The Nissen fundoplication is a surgical procedure used to treat gastroesophageal reflux disease and hiatal hernia. It focuses on correcting the lower esophageal sphincter (LES) by lengthening the portion of the esophagus located in the abdomen, by tightening the esophageal hiatus, and by reinforcing the LES by wrapping the top portion of the stomach around the lower esophagus.

The Nissen fundoplication was created in the 1950’s and with other variations of the fundoplication has been the mainstay for surgical therapy for GERD. The surgical procedure is well studied and demonstrates good long term relief of reflux symptoms, superior improvement of acid regurgitation, resolution of reflux related problems, and good long term patient satisfaction. Some side effects of the procedure can include varying degrees of increased bloating, dysphagia, or flatulence after surgery when compared to medical therapy alone(1).

The Nissen fundoplication (which is a 360 wrap around the distal esophagus) has many variations including the Toupet which is a 270 posterior wrap, the Dor (a 180 anterior wrap), the Thal (a 270 anterior wrap), and many others. Your surgeon may chose any of these options based on surgeon experience, patient specific variables, and expected outcomes.

Candidates for the Nissen fundoplication include individuals who have failed medical management, choose to manage their GERD with surgery to stop or reduce medical therapy, have complications related to GERD such as Barrett’s esophagus, or have extra-esophageal manifestations such as asthma, hoarseness, cough or aspiration.

A comparison of the Nissen with other procedures can be found on our pros and cons page.

 

  1. Lundell L, Attwood S, Ell C, Fiocca R, Galmiche J P, Hatlebakk J, Lind T, Junghard O (2008) Comparing laparoscopic antireflux surgery with esomeprazole in the management of patients with chronic gastro-oesophageal reflux disease: a 3-year interim analysis of the LOTUS trial. Gut 57:1207-1213