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. A partial fundoplication may accompany surgery for achalasia (specifically, a Heller myotomy).

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.

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. It has also been known for the diathermy, a surgical instrument used during the procedure, to cause heat damage to the stomach wall. This damage can be as severe as perforation, which can lead to added complications such as peritonitis and sepsis.

History

Dr. Rudolph Nissen first performed the procedure in 1951, and the procedure therefore bears his name.