Laparoscopic Nissen Fundoplication

Video Type: CVideo
  • 2-5 min videos of a particular surgery or technique. These again show major events in the surgery
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Author: Ciro Andolfi
Specialties: General Surgery
Schools: University of Chicago
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A 51-year-old man seeks medical attention for intermittent chest pain. He describes the pain as “burning” and it has become increasingly frequent after meals over the last 4 to 6 months. In addition, he experiences regurgitation, and often wakes up at night with a feeling of choking. He has also noted hoarseness and cough. Proton pump inhibitors are very helpful for the heartburn and chest pain but do not improve the regurgitation. Long-term results have shown that a fundoplication provides control of reflux in about 90% of patients. To achieve these results the surgeon should focus on the technical elements of the operation, rather than on the eponyms. The technical elements of the operation are the following: (1) division of the short gastric vessels to achieve complete fundic mobilization; (2) extensive dissection of the distal esophagus in the posterior mediastinum to bring the gastroesophageal junction at least 3 cm below the diaphragm; (3) meticulous closure of the right and left pillar of the crus with non-absorbable sutures; (4) use of a bougie to decrease postoperative dysphagia; (5) a short fundoplication with three interrupted stitches placed at 1 cm of distance from each other (2-2.5 cm long). All these technical elements have been shown to positively impact long-term outcomes. Patients who are still symptomatic postoperatively must be thoroughly evaluated to identify the cause of failure, and treatment must be individualized.

  • Ciro Andolfi (The University of Chicago Medicine)
  • Marco G. Patti (The University of Chicago Medicine)


Editor Recruited By: Jeffrey Matthews, MD

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