Nissen fundoplication

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Diagram of a Nissen fundoplication.

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. It may accompany surgery for achalasia (more 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 around (-plication) 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.

The procedure is often done laparoscopically (keyhole surgery).

When used as a method to alleviate gastroesophagael 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 undo itself 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. Some patients experience severe diarrhea after this surgery, which some health care professionals refer to as IBS.